Pamela E. Jeter, Collin Rozanski, Robert Massof, Olukemi Adeyemo, Gislin Dagnelie, PLoVR Study Group; Development of the Ultra-Low Vision Visual Functioning Questionnaire (ULV-VFQ). Trans. Vis. Sci. Tech. 2017;6(3):11. doi: 10.1167/tvst.6.3.11.
Purpose: To develop and psychometrically evaluate a visual functioning questionnaire (VFQ) in an ultra-low vision (ULV) population.
Methods: Questionnaire items, based on visual activities self-reported by a ULV population, were categorized by functional visual domain (e.g., mobility) and visual aspect (e.g., contrast) to ensure a representative distribution. In Round 1, an initial set of 149 items was generated and administered to 90 participants with ULV (visual acuity [VA] ≤ 20/500; mean [SD] age 61  years), including six patients with a retinal implant. Psychometric properties were evaluated through Rasch analysis and a revised set (150 items) was administered to 80 participants in Round 2.
Results: In Round 1, the person measure distribution (range, 8.6 logits) was centered at −1.50 logits relative to the item measures. In Round 2, the person measure distribution (range, 9.5 logits) was centered at −0.86 relative to the item mean. The reliability index in both rounds was 0.97 for Items and 0.99 for Persons. Infit analysis showed four underfit items in Round 1, five underfit items in Round 2 with a z-score greater than 4 cutoff. Principal component analysis on the residuals found 69.9% explained variance; the largest component in the unexplained variance was less than 3%.
Conclusions: The ULV-VFQ, developed with content generated from a ULV population, showed excellent psychometric properties as well as superior measurement validity in a ULV population.
Translational Relevance: The ULV-VFQ, part of the Prosthetic Low Vision Rehabilitation (PLoVR) development program, is a new VFQ developed for assessment of functional vision in ULV populations.
PROs reflect the patient's perceived changes in QoL and visual ability, and thus are central to rehabilitative outcomes measurement. Massof31,32 conceptualized two complementary latent variables underlying patient-reported outcomes as: "value of living independently" and the "visual ability of independent living." The "value of living independently" construct can be thought of as the impact visual impairment has on the individual's life. One approach to measuring this construct is seen in the development of the Impact of Vision Impairment (IVI) scale, used to determine the effects of vision loss on adults and how they function in society.33–35 "Visual ability" can be thought of as determining how much difficulty a patient has in achieving the visual goals defined in the Activity Inventory developed by Massof et al.,36 "value" can be estimated by rating "importance" as the response, and "frequency" also reflects importance; "ability," on the other hand, can be estimated by rating "difficulty" as the response.37 This difficulty rating reflects the functional reserve,32,38 defined as the difference between the visual ability required to complete a task and the visual ability of the individual. Visual Functioning Questionnaires (VFQs) that measure "ability" rely on rating scale responses indicating the perceived level of difficulty of a task (e.g., impossible, very difficult, not difficult).39,40 Such ordinal responses provide a hierarchy or order to the activities probed, but do not give quantitative information as to the difference between them.41 Individuals differ from one another in terms of both the importance and the difficulty they assign to different tasks. Importance and difficulty are complementary measures underlying patient-reported outcomes and are important constructs to include in VFQ development.
PRO VFQs42 vary by intended population, item content, length, functional requirements (visual acuity [VA] range), eye disease, and dimensions probed.28,36,43–45 Very few VFQs have addressed the measurement of "ability" and "value" in a severe vision loss population. Finger et al.46 developed the Impact of Vision Impairment in Very Low Vision (IVI-VLV) instrument aimed at individuals with visual acuity in the better seeing eye of less than 20/200 or visual field diameter less than 10°, or both. The IVI-VLV contains items probing the "impact" of vision loss, on ADLs and VRQoL. However, a VFQ specifically measuring "visual ability" in nearly blind individuals (i.e., how well a person with profound vision loss, including those receiving a sight-restoring therapy, can perform activities using remaining vision and without assistance) would supplement this work.
In practice, there is a need for the development of both visual function measures and self-report functional vision instruments that can quantify the vision of prosthesis wearers and those volunteering for phase 1 trials of novel treatment modalities, at baseline and follow-up, as well as those with "native" profound vision loss. The range of vision afforded by artificial and sensory substitution devices, allowing rudimentary recognition of shapes, movement, and sources of light, is not adequately captured by standard clinical definitions.16 Therefore, the term "ultra-low vision" (ULV) was coined.16,47 Operationally, ULV is defined as, "vision so limited that it prevents the individual from distinguishing shape and detail in ordinary viewing conditions." This definition corresponds with two categories in the International Classification of Diseases (ICD-9/ICD-10) introduced by the World Health Organization (i.e., profound visual impairment [VA ≤ 20/500] and near-total blindness [VA ≤ 20/1000]. In our research, and as explained in a companion paper (Adeyemo et al., TVST, In Press, 2017), we included individuals with reported VA less than or equal to 20/500 in the better seeing eye, but also include the restored visual ability of retinal prostheses wearers.10 Admittedly, VA can be measured on the Early Treatment Diabetic Retinopathy Study (ETDRS) chart at 0.5 m down to 20/1600, implying that those with vision in this range can still see shapes. There is a major difference between the ideal situation of 100% contrast optotypes shown in a darkened exam room and the real world of uneven illumination and lower contrast, and one can think of a gradual changeover in vision below 20/500, where subjects may still be able to identify high contrast shapes such as optotypes, but where recognition of real-world objects, shapes, and details becomes increasingly difficult. "Counting fingers" is a case in point: people with 20/1600 ETDRS VA cannot count fingers at 0.5 m, and even those with 20/500 may find it challenging, depending on illumination and contrast. In addition, it should be noted that the remaining visual field may be patchy, so those with severe vision loss may be using islands of vision, contributing to their difficulty seeing shape and details.
The mathematical approach contained in Rasch analysis critically depends on the item difficulties and person visual abilities spanning matching ranges, so the scores assigned by the respondents cover the full range and vary among individuals. For this reason, a VFQ for use in ULV has to be calibrated in a ULV population. A different way of expressing this is the requirement that the instrument have content validity, that is, the items address activities that are informative about visual ability, and measurement validity (i.e., the items, persons, and responses form a coherent data set under the mathematical model). To develop a new VFQ specifically for use in a ULV population, we therefore need items describing visual activities that are representative of those carried out by individuals with ULV, and we have collected a large set of such activities. In a separate publication, we report the results of a focus group study, conducted as the first stage of the Prosthetic Low Vision Rehabilitation (PLoVR) program development effort (Adeyemo et al., TVST, In Press, 2017), and aimed at creating a broad inventory of visual activities characteristic of ULV (i.e., activities that require very limited vision), but cannot be accomplished blindly. The 760 visual activities reported by the focus group members in that study could be categorized into functional visual domains (reading/shape recognition, mobility, visual-motor, and visual information), but were found to be more appropriately characterized by visual aspects such as contrast, lighting, motion perception, familiarity, size, and distance. ULV participants in the focus groups described their ability to accomplish a task as dependent on these visual aspects. For example, whether a task is achievable with the person's rudimentary vision may depend on figure-ground contrast, such as black coffee in a white coffee mug. Thus, creating content valid for the ULV population requires taking these visual aspects into account, and a representative distribution of visual aspects as well as visual domains was a guiding principle in the choice of items for a VFQ targeted at individuals with ULV. In terms of visual domains, given the limitations of ULV the "reading" domain is reduced to "crude shape recognition" in this population, and will be designated as "shape" in the remainder of this paper.
Here, we report on the second stage in the PLoVR program development (i.e., the creation and psychometric evaluation of a VFQ in a ULV population) called the ULV-VFQ. The advent of retinal prostheses and other sight-restoring therapies has made the development of such an instrument particularly timely, but the ULV-VFQ also represents the first PRO instrument specifically targeting "ability" in individuals with native ULV as low as bare light perception, allowing estimation of their visual ability and offering the opportunity to measure their visual ability as their vision evolves and potentially benefits from training or novel treatments.
This study was conducted between January 2013 and March 2014. Here, we describe the generation of items used in the questionnaire, the administration of the items to ULV participants and the psychometric evaluation in an iterative process, as steps in the development of a calibrated instrument. The study protocol was approved by the institutional review board of the Johns Hopkins University School of Medicine and followed the tenets of the Declaration of Helsinki. All participants gave informed consent for study participation after explanation of the nature, possible risks and benefits of the study.
Participants were recruited from the Low Vision Clinic of the Wilmer Eye Institute at Johns Hopkins Hospital (Baltimore, MD), through advocacy groups (e.g., Foundation Fighting Blindness, the National Federation of the Blind) and online forums for the blind and visually impaired, and through email and flyers to eye care providers and prospective participants nationwide. Participants had to be at least 10-years old, be proficient in spoken English, and meet our only visual inclusion criterion: a history of vision in the counting fingers/hand motions/light perception range (VA ≤ 20/500 in the better eye) as determined by medical records.
In Round 1 of the survey administration, there were 90 participants. All participants were legally blind with VA less than or equal to 20/500; most had lost form vision, with 73% reporting usable vision at the time of survey administration. Our sample was comprised of 67% participants with inherited retinal degenerations, including six retinal implant recipients who took part in the Argus II feasibility study.50 The same participants were included in Round 2, with the exception of 10 participants who opted not to participate or were not available during the second round of administration. Considerable effort was required to recruit qualifying participants, as ULV individuals represent a small subset within the legally blind population51; many prospective participants were screened out (e.g., if they indicated being able to read magnified print).
Questionnaire items were developed and written by two authors (PEJ and CR) based on the functional activities described in the focus groups, and reviewed and refined by all members of the study team. Items were tagged by category according to functional visual domain and visual aspect (Adeyemo et al., TVST, In Press, 2017) to ensure a representative distribution of items across all categories. Generally, items were worded as: "How difficult is it to [do this activity] using your remaining vision?" We emphasized using only vision, without or with the use of visual assistive devices, such as a magnifier (see Supplementary Materials S1 for instructions and items).52 The ordered difficulty ratings were similar to those used by Massof et al.36 during the development of the activity inventory and consisted of: not difficult, somewhat difficult, very difficult, impossible to perform visually, and not applicable. Items were uploaded to SurveyMonkey (SurveyMonkey, Inc., Palo Alto, CA, USA), which was then used by a research assistant for administration over the phone, or by the participant for online self-administration, according to preference. Participants with access to computers who were comfortable with the use of voiceover and other speech output software typically elected to respond online. According to the SurveyMonkey log, questionnaire administration took less than 1 hour for both phone and self-administered routes. Two rounds of the questionnaire were administered, with a revision after Round 1 based on psychometric properties and participant feedback. Additional information was collected each round to gauge current usable vision as reported by each participant.
Person-item maps were plotted to represent item difficulty and person ability measure estimates along a common interval scale in logits (i.e., log odds ratio unit),54–56 with mean item difficulty at 0 (by convention).54 This person-item map was used to compare the distributions of item difficulty and person visual ability estimates.55 In order to test content and measurement validity of the estimated measures, we used fit statistics, allowing us to examine how well the Rasch model predicts the response of each respondent to each item.55 Mean square fit statistics were calculated to evaluate the assumption of unidimensionality. Infit (Information-weighted sum) and outfit (outlier sensitive mean squares) quantities were computed to determine reliability of the latent variable measurement.49,54 Person reliability was calculated to evaluate the replicability of person ordering that we would expect if the same sample population were given a parallel set of items. Item reliability was calculated to determine item placement consistency along the variable axis, should these same items be given to another sample population of similar characteristics.54 Principal component analysis (PCA) was conducted on the second round residuals to determine if the latent trait is one-dimensional (i.e., if more than one latent variable would be required to explain the variability).57 Differential item functioning (DIF) tests were carried out to examine whether certain categories of respondents (e.g., Argus II users; those responding online; those who report that they no longer use their vision) judge item difficulties differently from the remaining respondents, which would refute the hypothesis of a common visual ability variable. Similarly, differential person functioning (DPF) was applied to categories of items that might assign different ability rankings to some categories of respondents.
Table 1 describes the demographic, socioeconomic, and other characteristics of the total participant sample (n = 90). The median age was 61 years (range, 24–103 years), and 47% of the participants were female. Remarkably, even though this was in no way a selection criterion, 78% of all participants had a form of inherited of congenital retinal dystrophy.
Table 2 shows the distribution of items according to content; this distribution follows that identified in the focus group responses (Adeyemo et al., TVST, In Press, 2017). Note the large number of items characterized by high contrast (∼60%) and lighting (∼14%). This method of item generation yielded 149 questions for the first round questionnaire and 150 for the second round questionnaire. Items were worded at an eighth grade reading level according to a Flesch-Kincaid Grade Level Test.
In Figure 1, a histogram of estimated person logit scores is plotted to the left side of the vertical axis, with a discernable person measure range from −6.0 to +2.8 logits; the item score histogram is plotted to the right side, with an item measure range from −3.3 to +3.0 logits. The ordering of estimates and the assignment of relative values via logit scaling are essential features of measurement.41 More difficult items and more able persons are located toward the top (i.e., >0), while the less difficult items and less able persons are located toward the bottom (<0) of the scale. The mean of the person distribution is offset by −1.55 logits relative to the mean of the item responses (0.0 logits, by convention). Relative to the 9-logit range of person measures, the items in this sample showed a range less than 6.5 logits and were moderately well-targeted, according to criteria formulated by Pesudovs.56 From this figure, it is evident that the initial version of the instrument was able to discriminate between less and more able participants. However, when comparing the distributions of item and person scores, there were only approximately five items in the "less difficult" range to map the approximately 25 "less able" persons with logit scores less than −2.50, suggesting that additional easy questions were needed, either by substituting easy questions for more difficult ones, or by modifying some items to make the described tasks easier.
The reliability index was 0.97 for items and 0.99 for persons in the Round 1 analysis, indicating that the model fit is of sufficient quality for the estimates to be interpreted as interval level measures. A mean value of 1 was found for the infit and outfit mean squares, indicating that the items and persons contributed reliably to the measurement of the latent variable (i.e., visual ability) and showing that the data are compatible with the Rasch model.
Standardized fit statistics (i.e., z-scores) of estimated person measures in Round 1 are shown in Figure 2 (Person Bubble Chart [top]) with each bubble diameter corresponding to the standard error of the person measure estimate. In the first round (N = 90), person estimates were compatible with the model with the exception of three participants (outliers) with z-scores greater than 4 (underfit), suggesting that their responses are less predictable than expected by the model. Upon inspection of the individual data, nothing of note was determined for these individuals' degree of vision loss, diagnosis, or age. Overfitted person estimates do not add any new information to the model fit: they are more predictable, but this is of no concern.
Standardized fit statistics (Round 1): person (N = 90; top) and item (N = 149; bottom) measures.
Item measures for Round 1 are plotted in Figure 2 (item bubble chart; bottom). Four items (outliers) were estimated beyond the z-score cut-off of 4 (underfit). Upon inspection, it was determined that the two closer outliers represented ambiguous items (numbers 2 and 76; see Supplementary Materials S1) and could be reworded. The two farthest outliers queried the respondent's ability to adjust to changes in lighting (e.g., entering into a dark building on a sunny day), items that were inherently variable, because they are known to be more difficult for retinitis pigmentosa patients than for others. This may be important information, and because only two items were affected it was decided to retain these two items for Round 2 administration of the questionnaire.
To determine if there were any differences in responses between subsets of participants, we performed a DIF analysis along three dimensions: (1) online versus phone administration, (2) remaining usable vision versus self-reported functional blindness, and (3) Argus II use versus native ULV. Because the DIF analysis was carried out on 149 items, a Bonferroni correction was applied, changing the required P value from 0.05 to 0.0003; therefore, even though on each of the three analyses several items showed raw probabilities below P equal to 0.01, no items reached significance, and no evidence for model differences was found along any of the three dimensions examined.
In a similar analysis, performed to examine the two misfitting items dealing with light and dark adaptation for DPF, no significant difference was found.
Based on participant feedback in the comment sections during the first round, some items were flagged as ambiguous. For example, in Round 1 of the survey, one question (number 48, see Supplementary Materials S1) was, "When playing a piano, how difficult is it to see the difference between the black and white keys?" However, several participants noted that this depends on the lighting in the room. Because we wanted this to be a high contrast question, we revised the sentence to rule out any ambiguity due to lighting. The revised question read, "When playing a piano in a well-lit room, how difficult is it to see the difference between the black and white keys?" In most cases, the visual aspect categorization stayed the same (Table 2 and Supplementary Material S1), but the item needed precision in order to hone in on the visual aspect of interest. In general, items were flagged for revision if they were considered imprecise, redundant, or unnecessarily visually demanding as judged by consensus between two authors (PEJ and CR). In some cases, demanding items were removed and simpler ones were inserted based on other activities reported by the focus groups (Adeyemo et al., TVST, In Press, 2017). With these considerations in mind, adjustments were made to a large majority of the items; most of them minor, and a second version of the questionnaire with 150 items was generated and administrated to the participants (see Supplementary Materials S1 for all items).
The reliability index in Round 2 was 0.97 for Items and 0.99 for Persons, similar to those in Round 1. In standardized test statistics for Round 2 person measures (Fig. 4; top), six of the participants had estimated response z-scores greater than 4, suggesting that their responses were less predictable (i.e., more variable). In standardized statistics for the item measures (Fig. 4; bottom), four items were estimated beyond a z-score of 4 including the two items querying the ability to adjust in sudden light changing situations. Overall, the second round of questionnaire showed good performance. In all cases, the effect of the outliers on the overall fit was negligible as determined by the PCA described below.
Standardized fit statistics (Round 2): person (N = 80; top) and item (N = 150; bottom) measures.
In Figure 5, Round 2 item measures are replotted with color codes according to visual aspects (top) and visual domains (bottom). The visual aspects distribution supports participants' descriptions of what allows them to accomplish a particular task: items determined by luminance and illumination are easier (lower in the figure), while those determined by familiarity, movement, size, and distance require more vision (higher item measures); items determined by contrast span a wider range. In the visual domains distribution, the "shape" items are confirmed to be more difficult than those falling in other domains.
Round 2 item measures as visual aspects (N = 150; top) and domains (N = 150; bottom).
The explained variance in Round 2 was estimated at 69.9%, and PCA was conducted on the residuals (i.e., the unexplained variance). This 30.1% of the variance represents measurement noise; this noise may be random, but it may include systematic deviations from the model, and PCA can uncover such deviations. As Figure 6 shows, the first principal component of the residual variance explains only 2.6% of the total variance, and each component after that explains less. The absence of major systematic deviations from the Rasch model indicates that the data set is internally consistent, with a single latent variable, and that the instrument yields a valid measurement.
Using content elicited from a ULV population (Adeyemo et al., TVST, In Press, 2017), including six Argus II Retinal Implant wearers, we developed a self-report questionnaire, the ULV-VFQ, as part of the PLoVR program development. Items were classified according to visual aspects (e.g., contrast) required to complete the task and according to visual domains, and reflect activities that individuals with ULV are able to accomplish with their remaining vision including visual assistive devices, but which they could not accomplish based solely on other sensory input. The instrument characteristics were psychometrically evaluated using Rasch analysis and found to meet the criteria for measurement that include hierarchical ordering and interval scaling41; moreover, the latent variable underlying the responses was determined to be unidimensional, and can be characterized as visual ability. The ULV-VFQ covers a wide range of item difficulties and can differentiate among different levels of ability among individuals with ULV. Fit statistics were determined to be excellent, and only a few items were underfit; PCA showed that the hypothesis of a unidimensional latent variable is sustained by the responses from our sample of 80 to 90 ULV individuals.
Because of the generally good fit statistics and the absence of DPF, we decided not to eliminate any underfitted items, including the two items dealing with light and dark adaptation. This decision was taken on advice of coauthor RWM, with the argument that retaining these items would have a negligible effect on the overall fit in the Rasch analysis and that, even if they might show DPF for RP patients versus others in a larger population of individuals with native and restored ULV, having these items may be a useful measure to classify individuals with ULV. In general, there is a downside to eliminating misfitting items, especially if they are felt to probe important information.
For similar reasons, and supported by the absence of DIF for any subgroups in our subject population, we feel that we are justified in basing the best estimates for the 150 item measures in the ULV-VFQ on two modes of administration (phone and online), a mixture of currently and formerly sighted individuals, and a subset of individuals with an Argus II retinal prosthesis.
There are several limitations to the study that are worth of mention. Despite casting a wide net to recruit as many participants as possible, we found that ULV individuals were difficult to access. This is supported by the low prevalence of ULV among the visually impaired served by low vision clinics reported in a multicenter study51: among 646 participants, only 39 were within the ULV range. In this study, we were able to recruit 90 eligible participants. The majority of our participants were diagnosed with an inherited retinal degeneration, but other diseases were also represented. We have no way of knowing whether the high percentage of retinal degeneration in our sample is representative of the ULV population in general: none of the blindness statistics provided by national or state registries differentiate between legal blindness with form vision, legal blindness without form vision (i.e., ULV), and total blindness. Most of our participants had end stage vision loss, and we thus had no way of knowing if they had predominantly peripheral or central areas of remaining vision, unless it was self-reported. Additionally, we were unable to determine of the presence or absence of color vision in our population. However, participants in our focus groups study (Adeyemo et al., TVST, In Press, 2017) all reported that the appearance of color has been reduced to brightness differences, in almost all situations. Our focus in choosing items for the ULV-VFQ was on what our population was able to do with their remaining vision. Regardless of the actual distribution of the causes of vision loss, both our focus group study (Adeyemo et al., TVST, In Press, 2017) and the current study show that individuals with ULV do use their remaining vision, but depend on high contrast and good lighting for it to be effective. Because our study population was recruited from locations across the country (USA), we relied on eye examination records to estimate visual function. Quantifying visual measures at the level of ULV is difficult, in any case. We did not collect specific information about comorbid conditions, other than verifying that the participants were in good general health and had no trouble understanding the instructions and questions.
Questionnaire items were worded at an eighth grade reading level according to a Flesch-Kincaid Grade Level Test analysis; however, it is possible that variation in item readability existed within the instrument.58 More importantly, the directions for the questionnaire were long and written at the 11th grade level. Most of our participants (∼86%) reported a greater than high school education, and the wording in those instructions would be familiar to an educated person with longstanding visual impairment. Furthermore, most of our participants responded by phone (70%) and the test administrator was able to clarify any confusing language in the instructions. Finally, the consistency in responses suggests that participants understood the instructions; any misunderstandings would have introduced additional variance into the data.
Despite our hope to recruit additional participants in visual prosthesis and gene therapy trials, the only such participants in our sample were Argus II users available at the time of Round 1 administration (i.e., prior to Argus II approval by the FDA). We did not have access to a population participating in other vision restoration treatments. Argus II users in our sample showed no significant difference in their ULV-VFQ responses from other participants according to a DIF analysis; in other words, our data provide no evidence that artificial sight is governed by a different kind of visual ability than native rudimentary vision. Further studies that include a larger cohort of retinal implant wearers and patients regaining vision through other treatment modalities will be required to explore potential differences between native and restored ULV. Incidentally, our data also indicated that neither the route of administration (online versus phone) nor the presence versus absence of residual usable vision affected the latent visual ability trait.
Commonly used VFQs36,44,45,59–61 vary by targeted visual disorder, age group, and so on, and are primarily aimed at the range of low vision that includes intact shape perception (i.e., better vision than ULV), with the notable exception of the IVI-VLV,46 aimed at individuals with VA less than 20/200, and responsive well below that. As reported earlier, the IVI-VLV queries respondents how much vision loss has "interfered" with their ADLs and VRQoL (e.g., "How much does your eyesight interfere with crossing the street?") reflecting a difference in the underlying latent variable measured, "impact" versus "ability." Because the two instruments measure a different latent variable, they are not equivalent, even if the subject populations were similar. The difference between the ULV-VFQ and IVI-VLV is perhaps best illustrated by comparing the least demanding item in the IVI-VLV "Activities of Daily Living, Mobility & Safety" subscale (i.e., "How much does your eyesight affect your general safety getting around at home?") to the corresponding item "When standing outside at high noon, how difficult is it for you to tell whether it is sunny outside?": while the IVI-VLV item probes limitations experienced getting around in a familiar environment (which may not require any sight), the ULV-VFQ specifically asks about the ability to see. This difference in item focus between the IVI-VLV and the ULV-VFQ causes the two instruments to be complementary rather than redundant. Both instruments have excellent psychometric properties: the person and item reliability indices are all greater than 0.90. A future comparison in an appropriately chosen sample will be very interesting and indeed, a holistic approach to vision rehabilitation is preferred. Additional comparisons with the IVI-LVL46 are worth mentioning. Our preference was to measure a tightly defined construct ("visual ability"), whereas the IVI-VLV measures two separate constructs: Activities of Daily Living, Mobility and Safety (ADLMS) and Emotional Well-being (EWB). We estimate ability by measuring difficulty (as a response category), whereas the IVI-VLV46 uses other response categories such as "frequency" (e.g., "a lot"), which are potentially contaminated because it is not known how often any given task needs to be completed by a particular individual to be qualified as "a lot." Finally, the IVI-LVL instructs participants to "Please answer about YOUR eyesight or activities with GLASSES, any AIDS and/or DEVICES, if you use them." These instructions do not stipulate that these assistive devices must be visual, and thus potentially introduce another confound, whereby a participant completes the task using other sensory input, such as tactile information when walking with a cane. In this example, it would be difficult, if not impossible, to discern what a participant is able to achieve with vision alone, which was the primary goal of the ULV-VFQ.
The ULV-VFQ probes how much participants are able to accomplish with their remaining vision. An important goal of the PLoVR development is to design instruments that track disease progression and changes in vision after visual restoration treatment and rehabilitation. We specifically designed the ULV-VFQ to measure functional reserve38 by querying respondents' ability to perform tasks visually, under precisely defined conditions. Thus the question: "How difficult is it for you to see a freshly-painted white crosswalk on dark pavement on a cloudy day?" seeks to eliminate ambiguity about the conditions and implies contrast as the specific visual aspect that was determined through earlier focus groups to be critical for successful task performance. In this example, if a patient received a retinal implant, end-stage vision loss is an eligibility criterion. The patient with end-stage vision loss is likely to already have orientation and mobility (O & M) skills. Here, we are most interested in the remaining vision available pre-implant versus that available post-implant and to measure that, we need a specific tool targeting remaining vision only, as nonvisual O & M skills are not likely to change dramatically. Whether O & M skills will improve following vision restoration will depend on the change in visual ability, so it is critically important that we are able to assess this separately from other abilities. This does not diminish the need to take non-visual abilities into account in a comprehensive rehabilitation approach. In that sense, the IVI-LVL and ULV-VFQ can complement each other in providing different perspectives on the patient's progress. What is important is that each instrument is cognizant of the latent variable it measures.
The ULV-VFQ was administered at a single time-point (i.e., cross-sectionally), and additional studies will be needed to determine the responsiveness of the instrument to treatment effects or disease progression. In its present form, it is also not ready for use in a clinical trial or rehabilitation program: a questionnaire with 150 items is lengthy, and items with similar difficulty may be redundant. Shorter62 and adaptive63 versions of the ULV-VFQ have been developed and are better suited for this purpose. On the other hand, we feel that there is merit to having a large set of items at this stage of development: not only can we continue to monitor these items for optimal fit properties as data are collected in larger groups of individuals with ULV, but also will we be able to draw from questions with similar item measures when for the computerized adaptive version of the ULV-VFQ and for standardized visual performance assessment through calibrated activities.
In conclusion, an instrument with 150 items, called the ULV-VFQ, was developed as part of the PLoVR program development program. It was determined, by Rasch analysis, to have excellent psychometric properties, measuring a unidimensional latent trait (i.e., visual ability). Future directions include administration to a larger ULV sample, including more retinal implant wearers and beneficiaries of other vision restoration treatments, to establish validity in a diverse population.
The authors thank Lauren Dalvin, Brianna Conley, Marilyn Corson, and Crystal Roach for data collection, entry, and management support.
Supported by a grant from the National Eye Institute (R01 EY021220) with GD as PI and an administrative supplement to PEJ.
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Wilke R, Bach M, Wilhelm B, Durst W, Trauzettel-Klosinski S, Zrenner E. Testing visual functions in patients with visual prostheses. In: Humayun MS, Weiland JD, Chader G, Greenbaum E, eds. Artificial Sight. Springer; 2007: 91–110.
Nau A, Bach M, Fisher C. Clinical tests of ultra-low vision used to evaluate rudimentary visual perceptions enabled by the BrainPort vision device. Transl Vis Sci Technol. 2013; 2 (3): 1–12.
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Haymes SA, Johnston AW, Heyes AD. The development of the Melbourne low-vision ADL index: a measure of vision disability. Invest Ophthalmol Vis Sci. 2001; 42: 1215–1225.
Klein BEK, Klein R, Jensen SC. A short questionnaire on visual function of older adults to supplement ophthalmic examination. Am J Ophthalmol. 2000; 130: 350–352.
Parrish RK, Gedde SJ, Scott IU, et al. Visual function and quality of life among patients with glaucoma. Arch Ophthalmol. 1997; 115: 1447–1455.
West SK, Munoz B, Rubin GS, et al. Function and visual impairment in a population-based study of older adults. The SEE project. Invest Ophthalmol Vis Sci. 1997; 38: 72–82.
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Stelmack J. Quality of life of low-vision patients and outcomes of low-vision rehabilitation. Optom Vis Sci. 2001; 78: 335–342.
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de Boer MR, Moll AC, de Vet HCW, Terwee CB, Völker-Dieben HJM, van Rens GHMB. Psychometric properties of vision-related quality of life questionnaires: a systematic review. Ophthalmic Physiol Opt. 2004; 24: 257–273.
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Ehrlich JR, Spaeth GL, Carlozzi NE, Lee PP. Patient-centered outcome measures to assess functioning in randomized controlled trials of low-vision rehabilitation: a review. Patient. 2017; 10: 39–49.
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Finger RP, Tellis B, Crewe J, Keeffe JE, Ayton LN, Guymer RH. Developing the impact of vision impairment--very low vision (IVI-VLV) questionnaire as part of the LoVADA protocol. Invest Ophthalmol Vis Sci. 2014; 55: 6150–6158.
Geruschat DR, Bittner AK, Dagnelie G. Orientation and mobility assessment in retinal prosthetic clinical trials. Optom Vis Sci. 2012; 89: 1308–1315.
Massof RW. An interval-scaled scoring algorithm for visual function questionnaires. Optom Vis Sci. 2007; 84: E690–E706.
Goldstein JE, Massof RW, Deremeik JT, et al. Baseline traits of low vision patients served by private outpatient clinical centers in the United States. Arch Ophthalmol. 2012; 130: 1028–1037.
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Welcome Derby Road three-part documentary series
Solent TV responds to Channel 4's Immigration Street
In recent months, Southampton has been gripped by the controversy arising from C4 and Love Productions' choice of Derby Road to shoot Immigration Street on, particularly in the light of the public reaction to their previous production of Benefit Street.
The series has put the spotlight on Derby Rd, a densely multi-ethnic road in St Mary's, close to the docks, opening old wounds from the times the area was known as a red light district throughout the world, and leaving a feeling that whatever they do, people of this area will always face prejudice.
With this local reaction running high, Solent TV, Southampton Solent University's student film unit, partnered with Sharp End Films to produce a unique access three-part series which shows the daily reality of Derby Road in a closer, unbiased look.
"The University is at the heart of the city and we are always making film projects in the community. We're proud to be portraying the vibrant streets of St Mary's and Derby Road," says Tony Steyger, Associate Professor at Southampton Solent.
Derby Road in Southampton is a microcosm of Great Britain today, rich in history and humanity. It has been home to generations of immigrants from around the world, who started settling here in the fifties, from Jamaica, Pakistan, India, Italy, Malta and so on. Derby Road, as one resident describes, is the "Initiation Road"; people settle here as new migrants and then move on to the roads nearby.
The documentary series, headed up by award-winning filmmaker and journalist Claudia Murg, has been working in partnership with Derby Road residents and people who work in the area, the NHS, the MPs, the local councillors, the Newtown residents association, the city council and police, to produce the three-part series 'Welcome to Derby Road' – a portrait of a multi-ethnic and multi-faith community which have been living in peace and harmony for decades.
"Working on these documentaries has been the most joyous experience", says Claudia Murg.
"People have welcomed us and put their faith in us to represent them in their true fair image. The commitment of these highly resourceful, and motivated people, completely focused on dealing with daily challenges of any inner city in Britain, and relentlessly finding solutions in tune with public opinion, will be thoroughly reflected in this unique-access series".
The trailer released is for the first of the three films to be shown on Solent TV (online) and other channels, to be confirmed, is 'Josie's neighbours', to be released at the beginning of March.
JOSIE IS an 82-year old feisty lady, who's lived in Derby Road since 1941, when she arrived as an eight year old with her Irish parents and brothers and sisters.
Josie takes us on a historical but critical journey through Derby Rd, starting with the 1940s – discussing living through the war and the impromptu street parties with her neighbours – through to the 1960s, and the emergence of the red light district, that made Derby Road so notorious so long ago in the past.
Josie's neighbours nowadays come from all over the world, but it is the old settled ethnic groups of Sikh Indians, Muslim Pakistani, the Windrush generation of Jamaicans, the West Indians that Josie sets out to discover more about. In this episode, Josie seeks to find out more about the values, achievements and impacts of these ethnic groups in the changing landscape of British society, meeting some of the first Jamaicans to settle in the area, as well as the Sikh Indians, Pakistanis and local Muslims.
Hearing first hand experiences from people who are often judged on their appearance, rather than their values, commitment to this country, and contribution, this episode focuses on what we have in common, the way we care about the world and about each other.
Alan Whitehead Labour MP, who was leader of Southampton City Council at the time where the biggest push for change took place, meets Josie in the serenity of the local paper's (Southern Daily Echo) library to look at some of the archive and discuss how it was for each of them, at the opposite ends of the line.
The next two episodes, to be show in April are:
'For the sake of the children, which tells the stories of parents from two continents, whose decisions to come to the UK have been based on the specific purpose of building a more secure future in the UK for their children. It focuses on people who are fairly new in the country and therefore first generation of immigrants.
'The listening project – film from the perspective of a few key people who work in Derby Road, for the health, safety and wellbeing of local people.
FOR FURTHER INFORMATION CONTACT THE MEDIA OFFICE ON 02382 013040 OR EMAIL press.office@solent.ac.uk

redpajama_set_name: RedPajamaCommonCrawl


Don't Eat Watermelon Seeds Pregnancy T-Shirt is perfect for any mommy to be who wants to announce her pregnancy in a fun, simple way.
Fun outfit for baby shower, baby sprinkle, gender reveal party, or new baby celebration. Fun shirt for pregnant women. Best for expecting mothers, pregnant mom during summer. Cute on the baby bump.
Cute gift to wear during summer.
This shirt is perfect for any vegan who want to protest speciesism and make people think about what they eat.


In order to obtain "Miami 23.6"" W x 23.6"" H Cabinet" By Evideco , look for quality hardwood joinery. In case a bit is fixed together or maybe fingernails and anchoring screws are widely used to maintain the furniture piece together, it does not last lengthy. It is recommended to spend more to obtain a "Miami 23.6"" W x 23.6"" H Cabinet" By Evideco with many outstanding hardwood joinery work on it. Really look at the legs of any "Miami 23.6"" W x 23.6"" H Cabinet" By Evideco you are looking for purchasing. Individuals thighs and legs will need not only to assist weight, they'll additionally be in contact with your flooring. Should they appear to be they'll do damage to your surface due to the materials used (like steel), then you might want to choose a diverse design. When buying "Miami 23.6"" W x 23.6"" H Cabinet" By Evideco for your personal family room, choose simple colors. You can affect the shades and other design in the space by altering accents, fresh paint along with other points. For that reason, it is possible to transform up the appearance of your living area without having to spend a lot of cash.
Within this fast evolving world of competition and development, it has been a proven fact that people barely get enough time to spend at their houses, looking after on their own. It's obligatory for all of us that we spend the vast majority of the days time in workplace, doing our responsibility. If the office lacks in correct tools and amenities for that workers, the workers get severe health problems. Similarly, the decorum and also the equipments of the offices are provided immense importance. These days, the majority of the tools are selected in a cautious manner so as to ensure the workers comfort and ease. One particular important item in the office may be the ergonomic workplace seats. As majority of the offices have ended up being wise, which means they rely more about machine than hard physical work, ergonomic workplace chairs are especially created for such offices. They are the chairs employed for the use of the offices getting computer workstations. These are specially designed chairs which help within the reduction of demands on the several anxiety of the spinal wires, thereby limiting the risk of muscle and neural diseases. Also they assist in maintaining the correct body position. It aligns the over arms, wrists, lower back, neck and the mind in the correct positions, thereby reducing lower back pain, work associated bone and joint problems and other this kind of illnesses. And when you simply looking for a chair to unwind, then think about among the recliner chair from our list. In the following paragraphs we will discuss about the top 15 best ergonomic desk seats to be able to provide the visitors with the correct understanding so that once they purchase this kind of seats, it might be easy for them to choose the correct one.
With nearly 100 5-star reviews, this lying loveseat is touted for its comfort and ease, sturdiness, look and easy assembly. In addition to gentle, but supportive soft cushions, it provides a gliding system, so that you can put your ft up and rock (though, not simultaneously.) Upholstered with extremely-durable glued leather, this reclining loveseat will resist tears, releases and stainswhich is a good factor, since it also features a storage space compartment system (where one can conceal your treats, obviously) and a two-mug owner. Whether you are settling set for a Blockbuster online binge or viewing football with your team, this reclining loveseat offers the durability and comfort with out breaking the bank.
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John RTA Copenhagen Selection 61 Loveseat in Marzipan is designed especially for little areas. Nevertheless, you can use it in almost any room: condo, dorm etc. This set provides you with more than enough assistance. It offers high grade material, high density froth pocketed coils, top-tier rayon fiber, and powerful hardwood frame. This adds to the comfort, sturdiness, and toughness of this established. The set also includes an extremely wide back shoulder straps. The established includes additional comfy pillows all which makes it much more comfortable. Notably, it's softly rounded hands and plush fabric to give it the outstanding look that matches with any style. The established list compact, therefore it's very easy to move. It has a minor scent that fades as time passes. More to the point, the couch is very simple to put together. It includes the assembling resources and instructions. You comfortably commit your cent hear. It serves the reason.
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The word here is the comfort and ease and sophisticated look. This set includes a tufted backrest and toe nail mind accent that gives it the sophisticated look. Its grey color adds to its impressive appear. It can fit as much as 8 inches bed mattress. That on your own lets you know how comfortable the established can be. Particularly, it doesn't incorporate a bed mattress. So you may want to purchase one. The trundle includes a castor to allow easy access. You may also pull the trundle that people take a seat on. Just to mention, it should take assembling, but again its super easy to assemble.
This ultra-elegant, higher-sovereign couch is designed to support cutting-advantage living room innovation. It's created as a 2-piece sofa couch combined with an attractive lounger. It also provides mobile armrests and advantageous back assistance. The gorgeous tapestry is finished with darkish false leather, firmly tufted. You can feel at ease cushioning with froth within the seat cushions. This guarantees a delicate sensation whenever you relaxation following a boring day time. The sofa is strengthened with wooden edge covered with dark synthetic leather. False tufted leather and powerful pinus radiata give severe brightness. It is true that it takes another look since it is more expensive than it truly appears to be. Talking about size, its huge! This is exactly what adds more stars to this established. The height is also remarkable for tall and brief people.


text:
Armless woman doesn't let her disability get in the way of her life
Britain may introduce a two-child limit.
Families should restrict themselves to having a maximum of two children to stabilise the effect on the environment of Britain's rapidly growing population, a think tank warns today.
According to the Optimum Population Trust, Britain's rising birth rate, currently growing at the highest rate for nearly 30 years, should be considered an environmental liability.
"Each new UK birth, through the inevitable resource consumption and pollution that UK affluence generates, is responsible for about 160 times as much climate-related environmental damage as a new birth in Ethiopia, or 35 times as much as a new birth in Bangladesh," the report says.
It calls on the government to introduce a "stop at two children" or "have one child less" guideline and to review incentives that may lead some teenage girls to become pregnant.
The author of the report, John Guillebaud, professor of family planning and reproductive health at University College, London, made the call after figures from the office of national statistics showed 669,531 babies were born in Britain last year, with the UK having the highest teenage pregnancy rate in western Europe.
All New Meaning of "BEWARE of DOG"
At 6ft 5ins (1.96m) on his hind legs, Samson must be the perfect guard dog. But to his owners, Julie and Ray Woods, of Boston, Lincolnshire, the three-year-old Great Dane-Newfoundland cross is simply a much-loved pet.
Samson - who weighs in at 125 kilograms = 275.6 pounds is being billed as "Britain's biggest dog" after scrap merchant staff who weighed him contacted the media.
Mrs. Woods says Samson has been "very unsettled" by the media interest and so she and her husband have ruled out any more photographs or filming.
She added: "He's a very placid, laid-back dog and I don't think he liked being ordered about - he just likes the quiet life." With video.
Labels: Animal's, In the News, Pictures
Armless woman doesn't let her disability get in th...


GHQ Military Museum is providing a service to the community not offered anywhere in this region. Normally to see such exhibits you would have to travel to locations that are usually many miles away. We have brought exhibits to communities in the past year and are working on expanding our services with our Mobile Museum Exhibits . With your assistance we hope to provide larger displays and attend more events.
Bronze---$250.00---Your name and logo on our website and recognition in our museum.
Silver---$500.00---All the above and choice of 2 GHQ t-shirts or 1 embroidered polo shirt.
Gold---$750.00---Including all the above your name or logo will be displayed at public events.
Your sponsorship which is tax deductable will help us obtain items such as a WWI uniform in good condition which can cost as much as $1000.00. The mannequin to display the uniform costs $200.00.
We greatly appreciate your consideration in helping us preserve our heritage.
We would like to thank the Will County Veterans Assistance Commission for becoming one of our silver sponsors!


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In 2010 the Veteran's District was allowed to use a portion of county land next to the Murphys Community Park for a large Veteran's Memorial. It includes a tall central flag pole with the emblems of all the branches of service on the base, handicapped accessible walkways, benches and a wall where families could purchase a brick engraved with the name of a veteran to memorialize them.
In 2014 the memorial was greatly enlarged due to the generosity of the John Kautz family, who designed and paid for the entire project. The central feature is a bronze statue of a soldier mounted on a large boulder. This new section was dedicated on Memorial Day 2014, with the Kautz family bringing in food tents and providing a free lunch for all veterans after the dedication. This addition to the memorial area also includes another wall for memorial bricks and picnic tables. The location, next to the creek and surrounded by trees, makes it a perfect spot.
California Code provides for Veteran's Memorial Districts to be formed as needed, with the memorial districts being allowed to provide and maintain memorial halls, assembly halls, buildings, or meeting places, together with suitable indoor and outdoor park and recreation facilities, including swimming pools, picnic areas, and playgrounds, for the use of persons or organizations other than veterans, and veteran soldiers, sailors, and marines who have honorably served the United States in any wars or campaigns recognized by law, or for the use of patriotic, fraternal, or benevolent associations of those persons.
Ebbetts Pass Veteran's Memorial District
Calaveras County, California
The Ebbetts Pass Veteran's Memorial District covers Calaveras County from Alpine County down to right above Vallecito, and from the Stanislaus River on the south to a boundary line going toward Sheep Ranch. There are five board members, serving terms of four years at a time, with at least three of them required to be veterans and all of them required to live in the district and be registered to vote in the district. The board meets once a month at their hall in Murphys. They planned, designed and have installed many flag pole memorials at fire stations, parks, cemeteries and other locations throughout their district.
In addition they provide new flags for schools and provide individual flags for the graves of all veterans buried in Buena Vista Cemetery in Murphys. The board members also march in parades in Arnold and Murphys, carrying the flags of each branch of the service, to increase awareness of veterans.
EPVMD'S FACILITIES
Contact Us/Order a brick
Names on the Walls
Ebbetts Pass Veteran's Memorial District © ALL RIGHTS RESERVED | Privacy Policy


Just a quick release to add a feature and fix one. The new feature is the ability to randomly sort the tag cloud. This option will show a completely different order of the tags to each visitor to your site. Not really earth-shattering, but it was asked for, so there it is.
The fix is in relation to the use of categories in the cloud. Due to laziness on my part, I released version 4.0 before thoroughly testing this aspect of the plugin. The problem was, your category links were being treated as tags, and therefore not getting a valid link created for them. This has now been fixed.
As always, you can find the download and comment on the plugin on the CTC page.


While conducting research with consumers of environmentally and socially responsible coffee between 2008 and 2009, I found that though most I spoke with were committed to this product, hardly any understood the distinctions between the different sourcing models available.
Given the number of options available in coffeehouses and grocers, this is not much of a surprise. The curious consumer will find Fair Trade, Organic, Rain Forest Alliance, Bird Friendly, UTZ Certified, and of course, variations on Direct Trade up for grabs. Inundated with information, labels and their claims blur together into an indistinguishable impression of goodness. Yet, somehow, Fair Trade seems to rise above the rest. Many consumers I spoke with used the term to refer to the concept of ethical sourcing in general. Many also assumed that "fair trade" was the only promise that they could trust, and that those not so labeled were inherently bad. In this post of the Direct Trade Coffee Club blog, we'll take a look at what Fair Trade certification really offers, how Direct Trade differs, and consider the room for improvement in each.
These days you can go to just about any coffee shop and they'll make a cup to suit the needs of your tastebuds. You can get a caramel-vanilla-mocha-frappe-cappuccino-whatever you want, and with whipped cream on top. Some coffee shops have taken this customization a step further by turning an ordinary cup of joe into a one-of-a-kind masterpiece that's (almost) too amazing to drink. Check out some amazing examples of latte art from around the web.
If you love coffee and art as much as we do, then you'll surely love these detailed coffee paintings by Maria Aristidou! Depending on the subject, she might dip her brush in around 5 different brews for a complete palette of shades. Her richly detailed paintings would be impressive even with normal watercolor paint, but these works are even more incredible when you consider she's making it with the stuff we like to chug on a regular basis.
"Buy coffee from a small, specialty roaster. A good roaster develops a relationship with the farms and co-ops that grow their coffee — it's in everybody's best interest for the coffee to be grown sustainably. The farmer gains by having a reliable buyer and a safe, healthy environment, and the roaster gains by having a reliable source of quality coffee. A conscientious roaster will have very specific information on the precise origin of each coffee it sells, and you can determine how the coffee was grown to guide your purchase."
"It's way past time that we stopped viewing coffee as something we all need to cut back on. It's a completely reasonable addition to a healthy diet, with more potential benefits seen in research than almost any other beverage we're consuming. It's time we started treating it as such."


During deer camp 2013, our crew had a nice walleye fish fry. I supplied the walleye and my dad supplied the potatoes from the farm. Needless to say, we had a great meal. Check out the pics from our deer camp walleye fish fry.
We went a little overboard!
Walleye should cook around 350 degrees.
Nobody wanted to eat the last piece!
A walleye fish fry is great any time of the year but a walleye deer camp fish fry in the snow is something to remember!


text:
Cover art by Mike Yuen
Cassandra Medley
Winner of the 2006 Audelco, August Wilson Playwriting Award
Race and science collide in Cassandra Medley's trenchant drama. Claire is a melanin scientist. She believes people of color are genetically superior — physically, mentally, in every way. Her daughter Kalima, a molecular geneticist at Johns Hopkins, knows otherwise, but to discredit her mother would destroy the relationship that each woman values the most. Forced to choose between science and family, between her future and her family, Kalima must decide where her loyalties lie.
Categories: The Plays Tags: African American
"The dramatically compelling argument spins off sparks about stem cell research, race and the Human Genome Project. But the gripping heart of Cassandra Medley's RELATIVITY is a showdown between relatives in a battle of the umbilical cord … RELATIVITY is a full-fledged drama bristling with challenging ideas and emotional complexity. It's a brave play. Not only has Medley set her drama, as one character puts it, 'on the cut of the cutting edge' of research, but she's also grappling with the very touchy subject of reverse racism … The mother-daughter bond is so tight, and so beautifully detailed in the writing … In Medley's RELATIVITY, passionate mass and intellectual energy equals pretty compelling drama." —Robert Hurwitt, San Francisco Chronicle
"RELATIVITY … offers dandy fringe benefits to go along with the heady science: … two especially dazzling scenes … the play is so entertaining …" —Neil Genzlinger, The New York Times
Cassandra Medley's most recently produced plays include: CELL, Ensemble Studio Theatre Marathon 2011, DAUGHTER, Ensemble Studio Theatre Marathon 2009, NOON DAY SUN, August, 2008, Diverse City Theatre Company — Theatre Row, New York City and RELATIVITY, a commission from the Alfred P. Sloan Foundation, Ensemble Studio Theatre, 2004. RELATIVITY, produced by Kuntu Rep. of Pittsburg, Southern Rep. of New Orleans, 2007, the Ensemble Studio Theatre, May, 2006, the St. Louis Black Repertory Theatre – February, 2006, and the Magic Theatre in San Francisco in June, 2004. CELL is published in the anthology Outstanding One-Act Plays — 2012, Dramatists Play Service. DAUGHTER published by Broadway Play Publishing, 2012. RELATIVITY won the 2006 Audelco August Wilson Playwriting Award and was featured on Science Friday, National Public Radio, and published by Broadway Play Publishing. RELATIVITY was featured in online radio broadcast of the play, Los Angeles Repertory Theatre – February, 2008. NOON DAY SUN was nominated for the 2008 August Wilson Playwriting Award. NOON DAY SUN is published by Broadway Play Publishing, Marathon 2004-06. Ms. Medley has also the received the 2004 Going to the River Writers Life Achievement Award, 2002 Ensemble Studio Theatre 25th Anniversary Award for Theatre Excellence, the 2001 Theatrefest Regional Playwriting Award for Best Play, the 1995 New Professional Theatre Award, and the 1995 Marilyn Simpson Award. She was a 1989 finalist for the Susan Smith Blackburn Award in Playwriting and won the 1990 National Endowment for the Arts Playwright Award. She was the 1986 recipient of the New York Foundation for the Arts Grant and a New York State Council on the Arts Grant for 1987. She teaches playwriting at Sarah Lawrence College, has taught at New York University, and has also served as guest artist at Columbia University, the University of Iowa Playwrights Workshop and Seattle University. Cassandra worked as a staff writer for ABC Television: One Life to Live – 1995 – 97. She is a playwright member of the Ensemble Studio Theatre, and New River Dramatists.
Originally produced by The Magic Theater, San Francisco
Relativity is produced
An American Journey
Kermit Frazier, John Leicht
A passionate retelling of the Daniel Bell incident, in which a black man was shot and killed while running from police officers.
Cast: 20 total (5 female, 15 male, multiethnic cast)
On the night in 1939 when Count Basie is to be the first black performer at the Palomar Ballroom next door, a pair of Bimini Baths attendants are tasked with cleaning up a stranger fished out of the La Brea Tar Pits.
A Preface to the Alien Garden
Robert Alexander
A PREFACE TO THE ALIEN GARDEN takes a hard look at the gangsta lifestyle in present-day Kansas City.
The Emperor Jones
Brutus Jones sets himself up as monarch of a Caribbean island and exploits his subjects ruthlessly until a uprising forces him to flee for his life.
MIRAGE, so like "marriage" in its spelling and some pronunciations, is about how much more interesting mundane situations could be if people would only apply themselves.
One Last Look
At his funeral, Eustace Baylor and his two families examine the tattered cloth of their lives. They find that if you would take one last look, you should take one first look.
Cast: 11 total (7 female, 4 male)
Lonnie Carter
THE GULLIVER TRILOGY presents the adventures of its hero, Lemuel Louis Gulliver, Citizen Candidate of the World, an extraordinary everyman, whose picaresque life begins in 1942 on Chicago's great South Side. In GULLIVER, Lemuel Louis Gulliver travels the globe releasing hostages and securing their votes with the help of Swift Ink, his production company.
Cast: 8 total (4 female, 4 male, multiethnic cast)
Pecong
Set "well in the past" on a fictional Caribbean island, the play tells the story of a sorceress who falls madly in love with a shallow womanizer.
Rain. Some Fish. No Elephants.
Y York
In the future, after the global ecological disaster, so much that makes life worth living has been outlawed. One family refuses to submit. Will their small act of rebellion lead to a future where science no longer dominates humanity but serves it?
Alma tries to reckon with injuries suffered by her beautiful daughter, Monique, while serving in the U.S. military in Iraq — injuries so severe that she no longer has a face.
Cast: 4 total (4 female)
Aishah Rahman
A farcical allegory in which the Greek prophetess Cassandra reappears as a contemporary victim of sexual harassment.


Recorded incidents of Anti Social Behaviour in Surrey, broken down by qualifier, ward and month.
Qualifiers are flags applied to an incident record, e.g. "Alcohol related", "Public place". Flags are applied at officers' discretion and so their use may vary. An incident record may have more than one flag, therefore rows will not sum to the total number of incidents recorded.
Month is based on the date an incident was reported to Surrey Police. This may be different from the date the incident occurred.
Data shown here is a snapshot of how incidents are categorised on the last day of the month.
Anti Social Behaviour categories are those defined by the Home Office National Standard for Incident Recording.
NOTE: The Home Office categorisations changed in April 2012 - "Total ASB" figures are therefore not comparable before and after this month.
Data is for "CAS wards" which were in place at the time of the 2001 Census. Please see "Geography Frequently Asked Questions" for further details.


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StrictlyVC: February 25, 2014
Happy Tuesday, everyone! Hope it's off to a good start.
Please do not give up on bitcoin, plead leading bitcoin startups, after Mt. Gox, once the world's biggest bitcoin exchange, went down yesterday. Its founder is still unaccounted for, reports Reuters. (According to the Winklevoss twins' new Winkdex, shares of bitcoin are currently trading at slightly less than $500. Since December, they've been as high as $1,163 and as low as $382. )
Paul Graham Gets Back to Basics
Y Combinator cofounder Paul Graham spoke at the Launch conference in San Francisco yesterday afternoon in a "fireside chat" with the event's founder, Jason Calacanis.
While it wasn't exactly a hard-hitting interview – these things are rarely intended to be – Calacanis managed to surface a lot during their conversation. Graham spoke at length about about Y Combinator's earliest days, for example; addressed a couple of the controversies he has found himself embroiled in over recent months; and explained the rationale behind his decision to relinquish day-to-day control over Y Combinator. (He's basically exhausted and wants his "brain back.") Calacanis also asked Graham plenty about what indicates to him that a startup might succeed or fail. Here's some of what Graham — whose platform has helped launch Airbnb, Dropbox, and Stripe, among more than 600 other companies — had to say:
On one of the quickest ways to get crossed off the list during an application interview with Y Combinator:
"The founders have to get along. If the founders hate each other, you're in big trouble," and it happens "very, very often," said Graham. "You don't know how good friends you are with somebody until you try to start a startup with them. That's why it works so badly when you have some startup that's started by some dude in business school who has this idea for some startup, and then he goes and finds some, like, 20-year-old meek, undergraduate computer science major to realize his vision, and that's the founding team … If you go into a Y Combinator interview, and one of you looks in terror to the other one before answering questions, that's one of our secret tells. Or if you roll your eyes while your cofounder is speaking, which has actually happened, or if you stand up your cofounder – like you don't show up for the interview… these have all happened."
On a founder type that Graham may have misjudged earlier on his career:
"The one thing is people who are very smart, but that's it. People who are very smart but ineffectual. We used to have more faith in brains. It turns out you can be surprisingly stupid if you're sufficiently determined. And anyone can tell this empirically. There are some parts of America where there are a lot of rich people and they're not very smart – parts of Manhattan and Florida and L.A. You don't have to be supersmart if you're fearsomely effective."
Calacanis asked him the most important thing for startups to focus on:
"There's a meta answer to that," said Graham. "The most important thing for startups to do is to focus, because there are so many things you could be doing, but one of them is the most important, so you should be doing that and not any of the others. So you should not be grabbing coffee with investors. When you want to raise money, you shift into fundraising mode and you go and raise money. You do not promiscuously meet with investors in the middle of the day when you should be working simply because they send you an email saying, 'Hey, let's grab coffee.' There are a 1,000 things you could be doing, and only one of them is the most important … and you work on that."
On the essence of growing a startup:
"You have to start with a small, intense fire. Suppose you're the Apple I. I think they made something like 500 of those things. So all they had to do was find 500 people to buy these things and they launched Apple. Apple! So you've got to find a small number of people – it's necessarily going to be a small number of people…who want what you're making a lot… You don't have to do any better than Apple and Facebook. You've got to know who those first users are and how you're going to get them, and then you just sit down and have a party with those first few users and you just focus entirely on them and you make them super, super happy."
(If you're interested in reading more from this interview, click here.)
AdStage, a two-year-old, San Francisco-based ad tech startup, has raised $1 million in seed financing from previous investor Digital Garage in a round that brings the company's total funding to $2.5 million. Others of AdStage's earlier investors include Freestyle Capital, Quest Venture Partners, 500 Startups, Launch Fund, XG Ventures and individual investors.
Quanttus, a two-year-old, Cambridge, Ma.-based maker of wearable devices, has raised $19 million in Series A funding from Khosla Ventures and Matrix Partners. The round follows a previous $3 million seed financing led by Vinod Khosla of Khosla Ventures.
Shape Security, a three-year-old, Mountain View, Ca.-based enterprise security company that automated malware and bots by way of a polymorphic security appliance that it produces, has raised $40 million in Series C funding led by Norwest Venture Partners and Sierra Ventures. Other participants in the round, which brings Shape's total funding to $66 million, included Kleiner Perkins Caufield & Byers, Venrock, Google Ventures, TomorrowVentures, and Allegis Capital.
SimilarGroup, a 6.5-year-old, Tel Aviv-based company whose sites analyze Web sites across the Internet, has raised an undisclosed amount of Series C funding entirely from Naspers, the South African multinational media group that owns minority stakes in major Internet companies, including Tencent and Mail.ru Group. TechCrunch sources say the Series C is in the tens of millions of dollars. Up to this point, SimilarGroup has raised $7.1 million, says Crunchbase, including from Yossi Vardi, the renowned Israeli investor.
SpareFoot, a 6.5-year-old, Austin, Tx.-based online storage marketplace, has raised $10 million in funding from earlier investor Insight Venture Partners. Its other major investors include Capital Factory, Floodgate and Silverton Partners. SpareFoot has raised $26 million to date.
TraceLink, a four-year-old, Woburn, Ma.-based company whose software helps companies connect, integrate, and collaborate with their supply chain partners, has raised $5.5 million in its first round of venture funding; it was led by FirstMark Capital.
Voalte, a five-year-old, Sarasota, Fla.-based healthcare-focused mobile communications platform, has raised $36 million in Series C funding led by Bedford Funding, a tech-focused private equity firm. Voalte's technology is designed help improve care coordination through voice calls, alarms and alerts and secure text messaging.
Athenahealth, the 17-year-old, publicly traded, Watertown, Ma.-based company that sells Internet-based business services to physician practices, is launching an accelerator to cultivate digital health care startups, reports Venture Capital Dispatch. The company says that demand for its services have surged as doctors look to outsource more, including billing; the accelerator hopes to come up with new services more quickly. According to Venture Capital Dispatch, the accelerator plans to recruit two to three companies this year that will operate out of a 2,500 square-foot space at its headquarters and expects to house 10 companies altogether.
2U, a 6.5-year-old, Landover, Md.-based company that builds online learning platforms to help nonprofit colleges and universities in their student enrollment and other services, has filed the paperwork to raise up to $100 million in an IPO. The company has raised nearly $100 million in private funding over the years; its biggest shareholders include Redpoint Ventures, which owns 23.2 percent of the company; Highland Capital Partners, which owns 11.4 percent; Novak Biddle Venture Partners, which owns 11 percent; and Bessemer Venture Partners, which owns 8.3 percent.
Everyday Health, the 12-year-old, New York-based health sites operator and apps maker, has filed for an IPO valued at up to $115 million. The company has raised $30 million from VCs, according to Crunchbase. Among its biggest shareholders are: WF Holding Company, which owns 25.4 percent of the company; Rho Ventures, which owns 25.4 percent;Scale Venture Partners, which owns 7.2 percent; Foundation Capital, which owns 5.2 percent; and NeoCarta Ventures, which owns 5.2 percent.
BlueKai, a 6.5-year-old, Cupertino, Ca.-based "intelligent marketing" company, was acquired yesterday by software giant Oracle. Terms of the deal weren't disclosed, but the outlet AdExchanger pegged the price at $300 million to $450 million. BlueKai is the fourth marketing and advertising tech company that Oracle has acquired in recent years. As AdExchanger notes, in May 2012, Oracle bought the social marketing software startup Vitrue for an estimated $300 million. It then purchased the marketing automation firm Eloqua for around $810 million in December 2012. And last December, Oracle acquired the email and cross-channel marketing software company Responsys for $1.5 billion. BlueKai had raised around $50 million from investors, including Redpoint Ventures,Battery Ventures, GGV Capital, Split Rock Partners, and e.ventures.
Cloudant, a 5.5-year-old, Boston-based cloud database startup, has been acquired by IBM for an undisclosed amount. Cloudant had raised roughly $16 million from investors, including Avalon Ventures, In-Q-Tel, andSamsung Ventures. GigaOm has more on the deal here.
Monster Worldwide yesterday announced that it has acquired TalentBin, a 3.5-year-old, San Francisco-based startup that used data to help recruiters discover hard-to-find technical talent, and Gozaik, a 20-month-old, Woburn, Ma.-based "social recruiting" startup that relied heavily on Twitter to find its job listings. Terms of the transactions were not disclosed. TalentBin had raised $3.2 million from investors, including First Round Capital, Charles River Ventures, Foundation Capital, Lightbank, andNew Enterprise Associates. Gozaik doesn't appear to have publicly disclosed any outside funding.
StopTheHacker, a 5.5-year-old, Burlingame, Ca.-based anti-malware firm, has been acquired by CloudFlare, a website security and content delivery service. StopTheHacker had raised just $1.1 million, reportedly, including from Runa Capital. Terms of its acquisition aren't being disclosed, says TechCrunch.
Veveo, a 10-year-old, Andover, Ma.-based intelligent search, personalization, and recommendation mobile phone service, is being acquired by Rovi Corp. for $62 million in cash and up to $7 million in additional cash payments based on certain milestones. Rovi supplies information on TV programs, movies, celebrities, books, games, and sports to content providers in more than 50 countries. Veveo disclosed just one, $14 million, round of funding in 2007, from Matrix Partners, Norwest Venture Partners, and North Bridge Venture Partners.
Investor Marc Andreessen says more net neutrality laws aren't going to help anything. Here's his point of view laid out in tweets.
In what's becoming an intriguing corporate governance battle, activist investor Carl Icahn has accused eBay board members Marc Andreessenand Scott Cook of conflicts of interest in a public letter published yesterday. Forbes has some of the strongest allegations here, including that Andreessen profited unfairly by participating in a consortium that bought a controlling stake of the eBay subsidiary Skype for $1.9 million. (The group sold Skype to Microsoft just 18 months later for $8.5 billion.) eBay quickly came to the defense of both board members, saying Icahn "unfortunately has resorted to mudslinging attacks against two impeccably qualified directors." Of Skype specifically, eBay said the "company explored all options for divesting Skype, including an IPO and sale to a strategic buyer, and pursued the option that offered the highest return at the time, which was the sale of a controlling stake."
Sibyl Goldman, executive vice president of new media at Ryan Seacrest Productions, has been recruited by Facebook to become its head of entertainment partnerships. According to Variety, Goldman will be based in L.A. and charged with building a bigger team focused on outreach efforts to studios, networks and celebrities. More here.
Yahoo CEO Marissa Mayer has reportedly been trying, without success, to recruit Mary Meeker of Kleiner Perkins Caufield & Byers to the company's board. Re/code, which has the story, notes that the last time Mayer added a renowned tech player, entrepreneur Max Levchin, it was late 2012.
Yesterday morning, on CBS, where he was promoting his newest book, Google Chairman Eric Schmidt was asked about reports that Google had bid $10 billion for the messaging service WhatsApp. His response: "Not in the way you're thinking about. We're certainly aware of them…Let me not talk about this specific conversation with WhatsApp. Let's just say that we like WhatsApp…and we like some other things, too, including our own products."
Ted Schlein, a longtime general partner at Kleiner Perkins Caufield & Byers, talked with Deborah Gage of the WSJ yesterday about some of the more interesting trends he's seeing around cyber security. Among his many observations: "Crowdsourced threat intelligence or vulnerability analysis is an idea that's going to be used by a lot of other parties to help us solve our problems because we ourselves can't afford to do that. AlienVault, the open threat exchange which is crowdsourcing the threats, is brilliant. Rather than buy a threat feed, you get it from the universe. It's the closest you'll get to real-time threat detection."
Eric Tilenius is the newly appointed CEO of BlueTalon, a Redwood City, Ca.-based big data startup that helps companies analyze information from both internal and external databases and that has just completed a $1.5 million seed round from Data Collective. Prior to joining BlueTalon, Tilenius was an EIR at Scale Venture Partners, and before joining Scale, he was a general manager at Zynga. (He has also served as CEO of Netcentives and Answers.com.) Tilenius told StrictlyVC last week of the move,"Ultimately, the team and product at BlueTalon won me over; I felt this was an incredible opportunity I could not afford to miss."
Launch Festival is rolling into its second day in San Francisco. You can learn more about the agenda here; to see a live stream of the event, use this link.
Mobile World Congress continues on in Barcelona. You can see a live feed here.)
Apparently, it's also not too late to register for the RSA Conference, happening all this week at San Francisco's Moscone Center. More information here.
Coinbase, the well-funded, San Francisco-based bitcoin startup that has been likened to an early PayPal, is looking for a business development exec. To apply, send your resume here.
Samsung revealed its Galaxy S5 yesterday at a trade show in Barcelona and it looks like a big hit.
A San Francisco-based high-tech writer was robbed of her Google Glassat a local bar last weekend while explaining to friends how the device works. After pursuing her attacker and getting the Glass back, a second assailant reportedly stole her purse and its contents. According to the San Francisco Chronicle, she was told that she and her friends were "destroying the city."
Ford is reportedly dropping Microsoft as a software partner to power its in-car entertainment and communications systems, in favor of, erm,Blackberry. (Tweeted Upstart founder Dave Girouard of arrangement: "Blackberry? Seriously? Ford moves from internal combustion engine to horse-drawn carriage.")
The difference between beacons and geofencing. (You already know this, of course. We include it for StrictlyVC's other readers.) H/T: MediaREDEF
American Aqueduct: The Great California Water Saga
A list of the "go-to" law schools, 2014 edition.
Sunday night, HBO broadcast the hilarious full trailer for Mike Judge's new series, "Silicon Valley," which debuts April 6. (We were already excited; now we can hardly wait.)
It's random, but this clip also made us horse laugh.
Starting to think about your next billion-dollar idea? You might use this to get inspired.
Throwing knives. For the friend who has everything(?).