Comparison of the EyeSys Corneal Analysis System and peripheral keratometry using a B&L keratometer and a lighted fixation device

The purpose of this study was to develop a keratometric device that would give a peripheral corneal measurement approximately 3.0mm from the center of the cornea and to compare the accuracy of the peripheral keratometry readings to an industry standard, a computerized corneal topographer. The EyeSys Corneal Analysis System by EyeSys laboratories in Houston, Texas, was chosen as a representative of available computerized corneal topographers. A fixation device, with peripheral fixation targets was created and attached to a standard Bausch & Lomb keratometer. Thirty-one subjects (five in the initial phase and twenty-six in the final phase) who were free from corneal disease and were not contact lens wearers, were subjects for this study. Each subject had four keratometric readings per eye taken 3.0mm from the center of the cornea and compared to the same location on their topographic map. Ninety-one percent of all readings fell within ±0.500. The device may prove to be a useful tool to aid in the base curve selection when fitting RGP lenses on both normal and pathologic eyes (i.e. keratoconus, post-keratoplasty and post-refractive surgery)

Genetic Background Can Result in a Marked or Minimal Effect of Gene Knockout (GPR55 and CB2 Receptor) in Experimental Autoimmune Encephalomyelitis Models of Multiple Sclerosis

PMCID: PMC379391

The Unintended Consequences of a Ban on the Humane Slaughter (Processing) of Horses in the United States

Federal legislation has been proposed to amend the Horse Protection Act to prohibit the shipping, transporting, moving, delivering, receiving, possessing, purchasing, selling, or donation of horses and other equines to be humanely slaughtered (processed) for human consumption, and for other purposes. The intent of the legislation is to enact a ban in the United States on processing horses for human consumption. The legislation does not provide fiscal support that would likely be needed to respond to an ever increasing number of unwanted, neglected, and abused horses. Often times horse neglect and abuse cases originate from a lack of economic resources needed to adequately maintain a horse’s health. While everyone fully supports and is committed to the humane treatment of all horses, there are unintended consequences of banning horse processing. The purpose of this paper is to identify and review the unintended consequences of a ban in the United States on the processing of horses for human consumption: 1. The potential for a large number of abandoned or unwanted horses is substantial. 2. Public animal rescue facilities are currently saturated with unwanted horses. No funding has been allocated to manage a large increase in horses that will likely become the responsibility of these facilities. 3. Cost of maintaining unwanted horses accumulates over time: A conservative estimate of the total cost of caring for unwanted horses, based upon 2005 statistics, is $220 million; Cumulative annual maintenance costs of otherwise processed horses, since the year 2000, would have exceeded more than$513 million in 2005. 4. The export value of horse meat for human consumption was approximately $26 million. A ban on processing would eliminate these annual revenues. 5. The option of rendering equine carcasses is decreasing. Private-land burial and disposal in landfills have a negative impact on the environment. 6. The Bureau of Land Management’s Wild Horse and Burro Adoption Program may be negatively impacted by a ban on horse processing. BLM horses and an increasing number of unwanted horses will be competing for adoption homes. Horse processing facilities offer a humane end-of-life option for approximately 1% of the United States horse population. Tens of thousands of horses could be neglected or abandoned if a processing ban were imposed. The direct economic impact and future unintended–and currently unaccounted for–economic impact of banning horse processing for human consumption are substantial. Proponents have not addressed the inevitable costs of such a ban. Horse owners will realize a direct impact from lower horse sale prices. Local and state governments will be adversely impacted by increased costs of regulation and care of unwanted or neglected horses

Climate change implications for tidal marshes and food web linkages to estuarine and coastal nekton

Climate change is altering naturally fluctuating environmental conditions in coastal and estuarine ecosystems across the globe. Departures from long-term averages and ranges of environmental variables are increasingly being observed as directional changes [e.g., rising sea levels, sea surface temperatures (SST)] and less predictable periodic cycles (e.g., Atlantic or Pacific decadal oscillations) and extremes (e.g., coastal flooding, marine heatwaves). Quantifying the short- and long-term impacts of climate change on tidal marsh seascape structure and function for nekton is a critical step toward fisheries conservation and management. The multiple stressor framework provides a promising approach for advancing integrative, cross-disciplinary research on tidal marshes and food web dynamics. It can be used to quantify climate change effects on and interactions between coastal oceans (e.g., SST, ocean currents, waves) and watersheds (e.g., precipitation, river flows), tidal marsh geomorphology (e.g., vegetation structure, elevation capital, sedimentation), and estuarine and coastal nekton (e.g., species distributions, life history adaptations, predator-prey dynamics). However, disentangling the cumulative impacts of multiple interacting stressors on tidal marshes, whether the effects are additive, synergistic, or antagonistic, and the time scales at which they occur, poses a significant research challenge. This perspective highlights the key physical and ecological processes affecting tidal marshes, with an emphasis on the trophic linkages between marsh production and estuarine and coastal nekton, recommended for consideration in future climate change studies. Such studies are urgently needed to understand climate change effects on tidal marshes now and into the future

Making the diagnosis of Chronic Fatigue Syndrome/Myalgic Encephalitis in primary care: a qualitative study

<p>Abstract</p> <p>Background</p> <p>NICE guidelines emphasise the role of the primary care team in the management of patients with Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME). A key stage in effective management is making an accurate early diagnosis, supported by appropriate referral.</p> <p>Methods</p> <p>A nested qualitative study within a multi-centre randomised controlled trial which aimed to explore GPs' views on their role in making the diagnosis of CFS/ME and subsequent management of patients in primary care. Semi-structured interviews with 22 GPs. Interviews were transcribed verbatim and an iterative approach used to develop themes from the dataset.</p> <p>Results</p> <p>GPs described difficulties in defining CFS/ME and suggested that their role in making a diagnosis was to exclude physical causes for the patient's symptoms, but they reported little confidence in positively attributing the label of CFS/ME to a patient and their symptoms. GPs suggested that the label of CFS/ME could be potentially harmful for the patient. The role of referral to secondary care was debated and GPs struggled defining their own role in management of this group of patients.</p> <p>Conclusions</p> <p>Until GPs feel comfortable making the diagnosis of CFS/ME and facilitating initial management, and have appropriate services to refer patients to, there will continue to be delays in confirming the diagnosis and patients presenting in primary care with fatigue may not receive appropriate care.</p> <p>Trial Registration</p> <p>ISRCTN 74156610</p

Literacy and blood pressure – do healthcare systems influence this relationship? A cross-sectional study

<p>Abstract</p> <p>Background</p> <p>Limited literacy is common among patients with chronic conditions and is associated with poor health outcomes. We sought to determine the association between literacy and blood pressure in primary care patients with hypertension and to determine if this relationship was consistent across distinct systems of healthcare delivery.</p> <p>Methods</p> <p>We conducted a cross-sectional study of 1224 patients with hypertension utilizing baseline data from two separate, but similar randomized controlled trials. Patients were enrolled from primary care clinics in the Veterans Affairs healthcare system (VAHS) and a university healthcare system (UHS) in Durham, North Carolina. We compared the association between literacy and the primary outcome systolic blood pressure (SBP) and secondary outcomes of diastolic blood pressure (DBP) and blood pressure (BP) control across the two different healthcare systems.</p> <p>Results</p> <p>Patients who read below a 9^thgrade level comprised 38.4% of patients in the VAHS and 27.5% of the patients in the UHS. There was a significant interaction between literacy and healthcare system for SBP. In adjusted analyses, SBP for patients with limited literacy was 1.2 mmHg lower than patients with adequate literacy in the VAHS (95% CI, -4.8 to 2.3), but 6.1 mmHg higher than patients with adequate literacy in the UHS (95% CI, 2.1 to 10.1); (p = 0.003 for test of interaction). This literacy by healthcare system interaction was not statistically significant for DBP or BP control.</p> <p>Conclusion</p> <p>The relationship between patient literacy and systolic blood pressure varied significantly across different models of healthcare delivery. The attributes of the healthcare delivery system may influence the relationship between literacy and health outcomes.</p

Repeat controlled human malaria infection of healthy UK adults with blood-stage plasmodium falciparum:Safety and parasite growth dynamics

In endemic settings it is known that natural malaria immunity is gradually acquired following repeated exposures. Here we sought to assess whether similar acquisition of blood-stage malaria immunity would occur following repeated parasite exposure by controlled human malaria infection (CHMI). We report the findings of repeat homologous blood-stage Plasmodium falciparum (3D7 clone) CHMI studies VAC063C (ClinicalTrials.gov NCT03906474) and VAC063 (ClinicalTrials.gov NCT02927145). In total, 24 healthy, unvaccinated, malaria-naïve UK adult participants underwent primary CHMI followed by drug treatment. Ten of these then underwent secondary CHMI in the same manner, and then six of these underwent a final tertiary CHMI. As with primary CHMI, malaria symptoms were common following secondary and tertiary infection, however, most resolved within a few days of treatment and there were no long term sequelae or serious adverse events related to CHMI. Despite detectable induction and boosting of anti-merozoite serum IgG antibody responses following each round of CHMI, there was no clear evidence of anti-parasite immunity (manifest as reduced parasite growth in vivo) conferred by repeated challenge with the homologous parasite in the majority of volunteers. However, three volunteers showed some variation in parasite growth dynamics in vivo following repeat CHMI that were either modest or short-lived. We also observed no major differences in clinical symptoms or laboratory markers of infection across the primary, secondary and tertiary challenges. However, there was a trend to more severe pyrexia after primary CHMI and the absence of a detectable transaminitis post-treatment following secondary and tertiary infection. We hypothesize that this could represent the initial induction of clinical immunity. Repeat homologous blood-stage CHMI is thus safe and provides a model with the potential to further the understanding of naturally acquired immunity to blood-stage infection in a highly controlled setting. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, identifier NCT03906474, NCT02927145

Long-term safety and efficacy of extended-interval prophylaxis with recombinant factor IX Fc fusion protein (rFIXFc) in subjects with haemophilia B

The safety, efficacy, and prolonged half-life of recombinant factor IX Fc fusion protein (rFIXFc) were demonstrated in the Phase 3 B-LONG (adults/adolescents ≥12 years) and Kids B-LONG (children <12 years) studies of subjects with haemophilia B (≤2 IU/dl). Here, we report interim, long-term safety and efficacy data from B-YOND, the rFIXFc extension study. Eligible subjects who completed B-LONG or Kids B-LONG could enrol in B-YOND. There were four treatment groups: weekly prophylaxis (20–100 IU/kg every 7 days), individualised prophylaxis (100 IU/kg every 8–16 days), modified prophylaxis (further dosing personalisation to optimise prophylaxis), and episodic (on-demand) treatment. Subjects could change treatment groups at any point. Primary endpoint was inhibitor development. One hundred sixteen subjects enrolled in B-YOND. From the start of the parent studies to the B-YOND interim data cut, median duration of rFIXFc treatment was 39.5 months and 21.9 months among adults/adolescents and children, respectively; 68/93 (73.1 %) adults/adolescents and 9/23 (39.1 %) children had ≥100 cumulative rFIXFc exposure days. No inhibitors were observed. Median annualised bleeding rates (ABRs) were low in all prophylaxis regimens: weekly (≥12 years: 2.3; <6 years: 0.0; 6 to <12 years: 2.7), individualised (≥12 years: 2.3; 6 to <12 years: 2.4), and modified (≥12 years: 2.4). One or two infusions were sufficient to control 97 % (adults/adolescents) and 95 % (children) of bleeding episodes. Interim data from B-YOND are consistent with data from B-LONG and Kids B-LONG, and confirm the long-term safety of rFIXFc, absence of inhibitors, and maintenance of low ABRs with prophylactic dosing every 1 to 2 weeks