Contributing to achieve the goal of VISION 2020

Most readers of this journal will have heard of the International Agency for the Prevention of
Blindness (IAPB), but they may not be aware of exactly what the organisation does and how it
functions. The purpose of this article is to give a brief overview of what IAPB does and how it
contributes to the elimination of avoidable blindness in the world.
The IAPB was established in 1975 as a coordinating umbrella organisation to lead international
efforts in the prevention of blindness.

IAPB presently has 97 members, which include: the major international nongovernmental
development organisations (NGDOs) involved in eye health, the international professional
bodies representing ophthalmologists and optometrists, universities, World Health Organization
(WHO) collaborating centres, some national eye care NGDOs, and five major corporate
institutions that fund VISION 2020 programmes.
IAPB's member organisations collectively deliver more than 1,500 eye health programmes, in
coordination with more than 1,000 partners in over 100 countries.

IAPB is the key partner that works on the VISION 2020 initiative with WHO, in particular the
WHO prevention of blindness and deafness unit (PBD). This close association, added to its
knowledge of eye health programmes based upon the experience of its member organisations,
means that IAPB is uniquely placed to provide strategic leadership to VISION 2020. Its work
adds value and contributes to the achievement of the initiative in the following specific areas:
knowledge and expertise, advocacy, promotion of VISION 2020 programmes for the prevention
of blindness, and coordination.

Knowledge and technical expertise

IAPB provides knowledge and technical expertise to support the development of quality eye
health programmes.

VISION 2020 workshops

IAPB works in partnership with the International Centre for Eye Health (ICEH) to deliver
annually more than twenty workshops that promote VISION 2020 around the world.
Topics include planning at national and district levels, specific disease control approaches, and
advocacy.

So far, 150 countries have participated in these workshops and 104 have developed a national
VISION 2020 plan. In the future, we hope that the IAPB regions and national coordinators for
blindness control will provide us with greater input as to workshop topics and target audiences.
What You Didn't Know About Earwax and Why You Need It

Earwax is something that most people feel compelled to clean from their ears. It is true . . . wax
can block-up the ear and cause discomfort. However, some earwax is essential for your ears. Too
little earwax fails to lubricate the ears properly and may impact your hearing. It also can cause
undue tension on your eardrums. Too much of a waxy buildup in the ears, however, can cause
painful inflammation and maybe even an infection. So how do you strike a balance? Let’s take a
look at the ways to keep your earwax in check . . .

How To Properly Clean Your Ears

The best way to prevent a buildup of earwax is by cleaning your ears . . . but not in the way you
might think and not as often as you may think, either. The best way to prevent earwax build up is
to clean out your ears with a solution that you pour into your ears and then tilt your head to pour
out. You should not stick anything in your ears, such as a cotton swab, as this may perforate the
eardrum. 

You can use something as simple and inexpensive as peroxide to clean out your ears - you do not
need to buy an “ear cleaner.” The best advice is to perform this action about once a month.
Again, you do not want to do this too often as you do not want your ears devoid of earwax as this
may stretch the eardrum too thin. Everything that your body produces has a purpose. And
Earwax’s purpose is to lubricate the ears!

Using a cotton swab to clean your ears is dangerous, not only because it can perforate the
eardrum, but because it can also push earwax further into the ear. It is always best to use an ear
solution or hydrogen peroxide to cleanse your ears. 

How To Tell If Your Ears Are Infected

Pain is the biggest indicator in people who have an ear infection. If you have an ear infection,
you need to see a doctor. They can provide you with medicine to stop the infection. Children are
most prone to ear infections. You can usually tell when a small baby has an ear infection as they
will tug on their ears and cry. If you suspect an ear infection, which is usually accompanied by a
fever, you should see your doctor or healthcare provider as soon as possible.

An earwax buildup can result in an ear infection. Although earwax is meant to drain naturally, in
some cases it may stay in the ear and become infected. In addition to antibiotics, a doctor may
proceed to flush out your ears. This will rid the ears of excess wax and will usually clear up the
infection. 

Natural Ear Wax Remedies

There are natural earwax remedies that are sold in the market. They generally consist of herbal
remedies that help to cleanse your ears and keep them free from earwax build-up. You may want
to try these harmless solutions if you are prone to ear infections. Check out your local health-
food store or alternative medicine shop.

Eardrops are also used when it comes to dissolving earwax. Eardrops are also commonly used in
cases of Swimmer’s Ear that can cause the symptoms of an ear infection and usually results from
water being “stuck” in your ear. 

You can also avoid ear pain by allowing your ears to properly drain after a shower: tilt your head
to each side and squeeze on the outer ear to rid your ears of excess water. Some say that lying on
your side and resting your ear on a heating pad can also draw excess ear wax from your ears.

And, while the jury is still out on whether ear candling is truly effective for removing excess
earwax, it seems to work well for some people.

And you thought all earwax was bad! Make sure to take good care of your ears by following the
advice above. 
Wearable technology provides ready-made monitoring for musculoskeletal rehabilitation

Musculoskeletal rehabilitation student researchers at the Spaulding Rehabilitation Hospital in

Boston are developing wearable monitoring systems that will allow physicians to monitor patient
activity and physiology remotely over extended periods. Physical rehabilitation–oriented
wearable technology research involves the design of minimally obtrusive sensors that can gather,
record, and relay information about a patient's physical movements or physiological state,
according to Harvard Medical School professor and Spaulding's motion analysis lab director
Paolo Bonato, PhD. It also promotes the development of algorithms for extracting information
from raw sensor data and providing clinically relevant feedback. Clinicians will be able to assess
the impact of physical rehabilitation interventions on patients' lives without interfering with their
activities of daily living (ADLs).

A common cause of movement disorder, Parkinson disease (PD) is characterized by tremor,

slowness of movement, and impaired postural balance. Dopamine augmentation/replacement
therapy has proved effective in managing PD symptoms, but its long-term use is correlated with
changes in brain function that cause dyskinesia. In addition, patient habituation to the
dopaminergic drugs tends to manifest in an abrupt loss of efficacy at the end of each dosing
interval.

To assess efficacy and adverse effects, physicians currently rely on patient self-reports and
diaries or on short-term clinical observation. However, these approaches are burdensome and
subject to perceptual and recall bias.
Clinical assessments tend to be more accurate but may be equally burdensome and represent only
a fraction of the patient's daily experience. Past attempts at using remote sensors proved
unsuccessful—the technology was neither reliable nor sensitive enough to capture the data
needed for clinical applications, and the amount of data required made storage and transmission
problematic.
Recent advances in miniature monitoring systems have made wearable technology more reliable
and sensitive for capturing patient movement characteristics associated with symptoms. Student
researcher Shyamal Patel's project is a wireless wearable monitoring system that accurately
tracks changes in the severity of symptoms in patients with PD. Patel developed procedures that
allow for processing of the clinical information at the sensor level and decrease the amount of
data and energy required for transmission.
Patel conducted a pilot study with a team led by John Growdon, MD, in the neurology division at
Massachusetts General Hospital (MGH). Medication intake, adverse effect occurrence, and
wearing off (abrupt loss of medication efficacy) were monitored in 12 patients with PD. Based
on the initial data, Patel developed signal-processing algorithms optimized for implementation
on the networked wireless sensors. Then he used advanced pattern recognition techniques to
accurately predict clinically relevant information about the severity of symptoms.

Patel's model will provide clinicians with a tool for designing treatment protocols based on
accurate, reliable data representing complex interactions of medications with multiple symptoms
monitored over time. The device will facilitate optimal medication titration and minimization of
adverse effects in individual patients; it also may serve as an objective measure of longitudinal
changes in patient status that occur because of the degenerative nature of PD and may provide a
way to collect data during clinical trials for new pharmaceutical and physical therapy treatments.
Researchers in neurorehabilitation have explored the repetition of movement patterns that
patients with hemiparesis (those experiencing unilateral weakness because of a stroke or a
traumatic brain injury) need to "relearn" as a tool for restoring motor function. Wearable sensor
technology may prove to be a powerful tool, especially when used with virtual reality and
robotics, according to students Fabrizio Cutolo and Chiara Mancinelli.

Virtual reality training platforms offer patients safe, often novel, environments in which they can
perform real-life motor tasks, and researchers gain a tool for collecting data on the patients' task
performance. The platforms may be designed to include visual, auditory, and haptic feedback
and to present patients with alternative motor strategies for completing salient tasks. These
features may be essential in motivating patients to perform the high-repetition protocols required
for motor skill reacquisition.
Virtual training offers the ideal mental environment for neurorehabilitation; rehabilitation
robotics provides the hardware that makes high-intensity, repetitive task performance physically
achievable for those with motor deficiencies. Advances in robotic technology have made these
devices suitable for facilitating the fine motor skills that tend to elude patients who have
neurological conditions. Rehabilitation robotic devices also serve as data collection tools,
enabling researchers to create better programs for individual patients.
The hand and finger movements of patients with hemiparesis lack the speed, coordination,
accuracy, and force demonstrated in healthy patients—they do not possess the precise motor
control required for manipulating objects. In patients with hemiparesis, upper extremity
rehabilitation robotic devices may help improve the proximal and fine motor manipulations
needed for performing ADLs. In addition, transfer of the learned movements into functional
tasks has been observed in patients with various degrees of severity and chronicity.
The use of conventional sensors to evaluate hand movements requires the application of
complicated and uncomfortable mechanical plugs. New technology has led to the development
of sensor-bearing substrates flexible enough to be manufactured as garments.
Cutolo and Mancinelli are developing an upper limb rehabilitation system that, by combining
robotics and virtual reality training with a comfortable sensing glove, will optimize motor
restoration in patients with hemiparesis. "Creating textiles with embedded sensing elements by
coating traditional fabrics with 'smart' materials has opened up new ways to implement the man-
machine interface technology," they said.

The researchers added a sensing glove as an alternative input device. The system, an adjustable
arm orthosis, reduces the effort required by the paretic arm to overcome gravity by passively
counterbalancing the weight of the arm; the device augments feedback through virtual
environments. Preliminary evidence supports the use of external support, such as that provided
by the device, in motor function restoration in patients with hemiparesis.
A Link between the Nervous System and Immunity in Skin

Many observations have led clinicians to speculate about the connection between immunity and
the nervous system. In fact, the linkage of stress and illness is considered common knowledge by
the lay public. The emerging field of psychoneuroimmunology has begun to elucidate the effects
of the central nervous system on immunity. However, until recently no direct physical and
functional connection was known. In this paper, the authors have demonstrated that Langerhans
cells are directly connected to cutaneous nerves in the epidermis. In addition, they have shown
that these nerves may regulate some of the functions of Langerhans cells.

The authors combined sophisticated laser microscopy with indirect immunofluorescence to show
that axons of cutaneous nerves made direct connections with 70% to 80% of epidermal
Langerhans cells. These nerves are rich in calcitonin gene- related peptide (CGRP), an important
neuropeptide and vasodilator. Some of the Langerhans cells appeared to be coated with CGRP.
The authors next examined the role of CGRP in Langerhans cell function. Normally, Langerhans
cells engulf and digest foreign substances in the skin, then travel to regional lymph nodes where
they "present" the antigen to T cells. The T cells then migrate to the skin and initiate an
inflammatory immune response against the foreign substance. When Langerhans cells are
exposed to CGRP they are unable to "present" antigen to T cells, and therefore cannot initiate the
cascade that leads to inflammation.

Comment: The implications of these results are remarkable. Dermatologists have long suspected
stress and anxiety have a role in such disorders as psoriasis and atopic dermatitis. This
observation may help explain the connection. In addition, a more basic puzzle may now be
solvable: since the skin is constantly bombarded with new and unusual foreign substances, why
isn't it constantly inflamed? The answer may be that Langerhans cells are usually prevented from
initiating inflammation by their innervation. Once they leave the local environment of the
epidermis (and CGRP) they are free to perform their function and initiate the immune cascade.