Cataract prevalence, cataract surgical coverage and barriers to uptake of cataract surgical services in Pakistan: the Pakistan National Blindness and Visual Impairment Survey.

AIM: To estimate the prevalence of visual impairment and blindness caused by cataract, the prevalence of aphakia/pseudophakia, cataract surgical coverage (CSC) and to identify barriers to the uptake of cataract services among adults aged >or=30 years in Pakistan. METHODS: Probability proportional-to-size procedures were used to select a nationally representative sample of adults. Each subject underwent interview, visual acuity measurement, autorefraction, biometry and ophthalmic examination. Those that saw <6/12 in either eye underwent a more intensive examination procedure including corrected visual acuity, slit lamp and dilated fundus examination. CSC was calculated for different levels of visual loss by person and by eye. Individuals with <6/60 in the better eye as a result of cataract were interviewed regarding barriers. RESULTS: 16 507 Adults were examined (95.5% response rate). The crude prevalence of blindness (presenting <3/60 in the better eye) caused by bilateral cataract was 1.75% (95% CI 1.55%, 1.96%). 1317 Participants (633 men; 684 women) had undergone cataract surgery in one or both eyes, giving a crude prevalence of 8.0% (95% CI 7.6%, 8.4%). The CSC (persons) at <3/60, <6/60 and <6/18 were 77.1%, 69.3% and 43.7%, respectively. The CSC (eyes) at <3/60, <6/60 and <6/18 were 61.4%, 52.2% and 40.7%, respectively. Cost of surgery (76.1%) was the main barrier to surgery. CONCLUSION: Approximately 570 000 adults are estimated to be blind (<3/60) as a result of cataract in Pakistan, and 3,560000 eyes have a visual acuity of <6/60 because of cataract. Overall, the national surgical coverage is good but underserved populations have been identified

Genome-wide association studies for corneal and refractive astigmatism in UK Biobank demonstrate a shared role for myopia susceptibility loci.

Previous studies have suggested that naturally occurring genetic variation contributes to the risk of astigmatism. The purpose of this investigation was to identify genetic markers associated with corneal and refractive astigmatism in a large-scale European ancestry cohort (UK Biobank) who underwent keratometry and autorefraction at an assessment centre. Genome-wide association studies for corneal and refractive astigmatism were performed in individuals of European ancestry (N = 86,335 and 88,005 respectively), with the mean corneal astigmatism or refractive astigmatism in fellow eyes analysed as a quantitative trait (dependent variable). Genetic correlation between the two traits was calculated using LD Score regression. Gene-based and gene-set tests were carried out using MAGMA. Single marker-based association tests for corneal astigmatism identified four genome-wide significant loci (P < 5 × 10-8) near the genes ZC3H11B (1q41), LINC00340 (6p22.3), HERC2/OCA2 (15q13.1) and NPLOC4/TSPAN10 (17q25.3). Three of these loci also demonstrated genome-wide significant association with refractive astigmatism: LINC00340, HERC2/OCA2 and NPLOC4/TSPAN10. The genetic correlation between corneal and refractive astigmatism was 0.85 (standard error = 0.068, P = 1.37 × 10-35). Here, we have undertaken the largest genome-wide association studies for corneal and refractive astigmatism to date and identified four novel loci for corneal astigmatism, two of which were also novel loci for refractive astigmatism. These loci have previously demonstrated association with axial length (ZC3H11B), myopia (NPLOC4), spherical equivalent refractive error (LINC00340) and eye colour (HERC2). The shared role of these novel candidate genes for astigmatism lends further support to the shared genetic susceptibility of myopia and astigmatism

Declination dependence of the cosmic-ray flux at extreme energies

We study the large-scale distribution of the arrival directions of the highest energy cosmic rays observed by various experiments. Despite clearly insufficient statistics, we find a deficit of cosmic rays at energies higher than 10^{20} eV from a large part of the sky around the celestial North Pole. We speculate on possible explanations of this feature.Comment: 5 pages, 4 figures; v2: 11 pages, 4 figures, title changed (to avoid confusion with the Southern hemisphere), analysis extended, more data included, results unchanged; to be published in JCA

Village-Integrated Eye Worker trial (VIEW): rationale and design of a cluster-randomised trial to prevent corneal ulcers in resource-limited settings.

IntroductionCorneal opacity is a leading cause of blindness worldwide. In resource-limited settings, untreated traumatic corneal abrasions may result in infection and ultimately, opacity. Although antimicrobial treatment of corneal ulcers may successfully cure infections, the scarring that accompanies the resolution of infection can still result in visual impairment. Prevention may be the optimal approach for reducing corneal blindness. Studies have employed community health workers to provide prompt administration of antimicrobials after corneal abrasions to prevent infections, but these studies were not designed to determine the effectiveness of such a programme.Methods and analysisThe Village-Integrated Eye Worker trial (VIEW) is a cluster-randomised trial designed to assess the effectiveness of a community health worker intervention to prevent corneal ulcers. Twenty-four Village Development Committees (VDCs) in Nepal were randomised to receive a corneal ulcer prevention programme or to no intervention. Female Community Health Volunteers (FCHVs) in intervention VDCs are trained to diagnose corneal abrasions, provide antimicrobials and to refer participants when needed. An annual census is conducted over 3 years in all study VDCs to assess the incidence of corneal ulceration via corneal photography (primary outcome). Masked outcome assessors grade corneal photographs to determine the presence or absence of incident corneal opacities. The primary analysis is negative binomial regression to compare the incidence of corneal ulceration by study arm.Ethics and disseminationThe University of California San Francisco Committee on Human Research, Nepal Netra Jyoti Sangh and the Nepal Health Research Council have given ethical approval for the trial. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication.Trial registration numberNCT01969786; Pre-results

Upper Bounds on the Neutrino-Nucleon Inelastic Cross Section

Extraterrestrial neutrinos can initiate deeply developing air showers, and those that traverse the atmosphere unscathed may produce cascades in the ice or water. Up to now, no such events have been observed. This can be translated into upper limits on the diffuse neutrino flux. On the other hand, the observation of cosmic rays with primary energies > 10^{10} GeV suggests that there is a guaranteed flux of cosmogenic neutrinos, arising from the decay of charged pions (and their muon daughters) produced in proton interactions with the cosmic microwave background. In this work, armed with these cosmogenic neutrinos and the increased exposure of neutrino telescopes we bring up-to-date model-independent upper bounds on the neutrino-nucleon inelastic cross section. Uncertainties in the cosmogenic neutrino flux are discussed and taken into account in our analysis. The prospects for improving these bounds with the Pierre Auger Observatory are also estimated. The unprecedented statistics to be collected by this experiment in 6 yr of operation will probe the neutrino-nucleon inelastic cross section at the level of Standard Model predictions.Comment: To be published in JCA

Gamma-Ray Constraints on Maximum Cosmogenic Neutrino Fluxes and UHECR Source Evolution Models

The dip model assumes that the ultra-high energy cosmic rays (UHECRs) above 10$^{18}$ eV consist exclusively of protons and is consistent with the spectrum and composition measure by HiRes. Here we present the range of cosmogenic neutrino fluxes in the dip-model which are compatible with a recent determination of the extragalactic very high energy (VHE) gamma-ray diffuse background derived from 2.5 years of Fermi/LAT data. We show that the largest fluxes predicted in the dip model would be detectable by IceCube in about 10 years of observation and are within the reach of a few years of observation with the ARA project. In the incomplete UHECR model in which protons are assumed to dominate only above 10$^{19}$ eV, the cosmogenic neutrino fluxes could be a factor of 2 or 3 larger. Any fraction of heavier nuclei in the UHECR at these energies would reduce the maximum cosmogenic neutrino fluxes. We also consider here special evolution models in which the UHECR sources are assumed to have the same evolution of either the star formation rate (SFR), or the gamma-ray burst (GRB) rate, or the active galactic nuclei (AGN) rate in the Universe and found that the last two are disfavored (and in the dip model rejected) by the new VHE gamma-ray background.Comment: 19 pages, 16 figures, JHEP3.cls needed to typese

Parental Alcoholism and Co-Occurring Antisocial Behavior: Prospective Relationships to Externalizing Behavior Problems in their Young Sons

The hypothesis that parental alcoholism and co-occurring antisocial behavior would be indirectly linked to child externalizing behavior problems through child lack of control, current levels of parent depression, family conflict, and parent–child conflict was tested using manifest variable regression analysis. Participants were a community sample of 125 families with an alcoholic father and 83 ecologically matched but nonsubstance abusing families involved in the first 2 waves of an ongoing longitudinal study (with 3 years between each wave). All families had a biological son who was 3–5 years old at study onset. Results revealed that child lack of control mediated the relation between paternal alcoholism and the son's subsequent externalizing behavior problems. Family conflict was a significant mediator of maternal and paternal lifetime antisocial behavior effects and father–son conflict mediated paternal lifetime antisocial behavior effects. Study implications are discussed within the context of parental socialization of antisocial behavior.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/44590/1/10802_2004_Article_294631.pd

Role of Educational Exposure in the Association Between Myopia and Birth Order.

IMPORTANCE: Visual impairment due to myopia is an important public health issue. A prior analysis of population-based cohorts aged 15 to 22 years recruited from the United Kingdom and Israel suggested myopia and high myopia were approximately 10% more common in first-born compared with later-born children. OBJECTIVE: To examine whether myopia was associated with birth order in an earlier generation than studied previously and, if so, whether the association was attenuated after adjusting for education exposure, as predicted by the hypothesis that the education of children with later birth orders is less intense. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of UK Biobank participants recruited from 2006 to 2010. Analysis was restricted to participants aged 40 to 69 years who had a vision assessment, self-reported white ethnicity, and no history of eye disorders (N = 89,120). Myopia and high myopia were defined as autorefraction of -0.75 diopters (D) or less and -6.00 D or less, respectively. EXPOSURES: Birth order and information on potential confounders including highest educational qualification ascertained using a structured questionnaire. MAIN OUTCOMES AND MEASURES: Odds ratios (ORs) for myopia and high myopia by birth order, using logistic regression and adjusting for age and sex (model 1) or age, sex, and highest educational qualification (model 2). RESULTS: In model 1 (no adjustment for education), birth order was associated with both myopia and high myopia (eg, comparing first- vs second-born individuals; OR, 1.12; 95% CI, 1.08-1.16; P = 1.40E-11 and OR, 1.21; 95% CI, 1.11-1.30; P = 3.60E-06 for myopia and high myopia, respectively). The risk for myopia became progressively lower for later birth orders, suggesting a dose response. In model 2 (after adjusting for education), the effect sizes were attenuated by approximately 25% (OR, 1.09; 95% CI, 1.05-1.12; P = 1.30E-06 and OR, 1.15; 95% CI, 1.06-1.25; P = 4.60E-04 for myopia and high myopia, respectively) and the apparent dose response was abolished. CONCLUSIONS AND RELEVANCE: These data suggest that the association between birth order and myopia is not due to a new environmental pressure in the last 30 to 40 years. The attenuated effect size after adjusting for educational exposure supports a role for reduced parental investment in education of children with later birth orders in their relative protection from myopia