TOZAL Study: An open case control study of an oral antioxidant and omega-3 supplement for dry AMD

BACKGROUND: The primary objective of this prospective study was to measure the change from baseline in visual function – Best-Corrected Visual Acuity (BCVA) via the Early Treatment Diabetic Retinopathy Study (ETDRS) chart, contrast sensitivity, central 10 degree visual fields and retinal imaging (angiograms and photographs) at 6 months in subjects with atrophic (dry) age-related macular degeneration treated with a targeted nutritional supplement. METHODS: 37 mixed gender patients with a mean age of 76.3 +/- 7.8 years were enrolled at 5 independent study sites and received standard of care with a novel formulation of a nutritional supplement. Results were compared to a placebo cohort constructed from the literature that was matched for inclusion and exclusion criteria. A paired t-test was used to test a null hypothesis and a two-sided alpha level of 0.05 was used to determine statistical significance. RESULTS: 76.7% of subjects receiving the nutritional supplement demonstrated stabilization or improvement of BCVA at 6 months. Subjects gained an average of 0.0541 logMAR or one-half of a line of visual acuity (VA) over the 6-month period. There was a statistically significant improvement in VA from baseline with P = .045. The results provide strong evidence that the treatment being studied produces an improvement in VA. CONCLUSION: Treatment with this unique nutritional supplement increased VA above the expected baseline decrease in the majority of patients in this population with dry macular degeneration. The results of the TOZAL study agree with the LAST and CARMIS studies and are predictive for positive visual acuity outcomes in the AREDS II trial. However, patients will likely require supplementation for longer than 6 months to effect changes in additional visual parameters

Prevention of age-related macular degeneration

Age-related macular degeneration (AMD) is one of the leading causes of blindness in the developed world. Although effective treatment modalities such as anti-VEGF treatment have been developed for neovascular AMD, there is still no effective treatment for geographical atrophy, and therefore the most cost-effective management of AMD is to start with prevention. This review looks at current evidence on preventive measures targeted at AMD. Modalities reviewed include (1) nutritional supplements such as the Age-Related Eye Disease Study (AREDS) formula, lutein and zeaxanthin, omega-3 fatty acid, and berry extracts, (2) lifestyle modifications, including smoking and body-mass-index, and (3) filtering sunlight, i.e. sunglasses and blue-blocking intraocular lenses. In summary, the only proven effective preventive measures are stopping smoking and the AREDS formula

America's Rural Hospitals: A Selective Review of 1980s Research

We review 1980s research on American rural hospitals within the context of a decade of increasing restrictiveness in the reimbursement and operating environments. Areas addressed include rural hospital definitions, organizational and financial performance, and strategic management activities. The latter category consists of hospital closure, diversification and vertical integration, swing-bed conversion, sole community provider designation, horizontal integration and multihospital system affiliation, marketing, and patient retention. The review suggests several research needs, including: developing more meaningful definitions of rural hospitals, engaging in methodologically sound work on the effects of innovative programs and strategic management activities—including conversion of the facility itself—on rural hospital performance, and completing studies of the effects of rural hospital closure or conversion on the health of the communities served.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/74857/1/j.1748-0361.1990.tb00682.x.pd

Philadelphia's gas problem;

Mode of access: Internet

Mobile demersal megafauna at artificial structures in the German Bight – Likely effects of offshore wind farm development

Within the next few decades, large underwater structures of thousands of wind turbines in the northern European shelf seas will substantially increase the amount of habitat available for mobile demersal megafauna. As a first indication of the possible effects of this large scale habitat creation on faunal stocks settling on hard substrata, we compared selected taxa of the mobile demersal megafauna (decapods and fish) associated with the foundation of an offshore research platform (a wind-power foundation equivalent) with those of five shipwrecks and different areas of soft bottoms in the southern German Bight, North Sea. When comparing the amount of approximately 5000 planned wind-power foundations (covering 5.1 _ 106 m2 of bottom area) with the existing number of at least 1000 shipwrecks (covering 1.2 _ 106 m2 of bottom area), it becomes clear that the southern North Sea will provide about 4.3 times more available artificial hard substratum habitats than currently available. With regard to the fauna found on shipwrecks, on soft substrata and on the investigated wind-power foundation, we predict that the amount of added hard substrata will allow the stocks of substrata-limited mobile demersal hard bottom species to increase by 25e165% in that area. The fauna found at the offshore platform foundations is very similar to that at shipwrecks. Megafauna abundances at the foundations, however, are lower compared to those at the highly fractured wrecks and are irregularly scattered over the foundations. The upper regions of the platform construction (5 and 15 m depth) were only sparsely colonized by mobile fauna, the anchorages, however, more densely. The faunal assemblages from the shipwrecks and the foundations, respectively, as well as from the soft bottoms clearly differed from each other. We predict that new wind-power foundations will support the spread of hard bottom fauna into soft bottom areas with low wreck densities