Investigation of the Accuracy of a Low-Cost, Portable Autorefractor to Provide Well-Tolerated Eyeglass Prescriptions: A Randomized Crossover Trial

Purpose: To compare patient preferences for eyeglasses prescribed using a low-cost, portable wavefront autorefractor versus standard subjective refraction (SR). Design: Randomized, cross-over clinical trial. Participants: Patients aged 18 to 40 years presenting with refractive errors (REs) to a tertiary eye hospital in Southern India. Methods: Participants underwent SR followed by autorefraction (AR) using the monocular version of the QuickSee device (PlenOptika Inc). An independent optician, masked to the refraction approach, prepared eyeglasses based on each refraction approach. Participants (masked to refraction source) were randomly assigned to use SR- or AR-based eyeglasses first, followed by the other pair, for 1 week each. At the end of each week, participants had their vision checked and were interviewed about their experience with the eyeglasses. Main Outcome Measures: Patients preferring eyeglasses were chosen using AR and SR. Results: The 400 participants enrolled between March 26, 2018, and August 2, 2019, had a mean (standard deviation) age of 28.4 (6.6) years, and 68.8% were women. There was a strong correlation between spherical equivalents using SR and AR (r = 0.97, P < 0.001) with a mean difference of −0.07 diopters (D) (95% limits of agreement [LoA], −0.68 to 0.83). Of the 301 patients (75.2%) who completed both follow-up visits, 50.5% (n = 152) and 49.5% (n = 149) preferred glasses prescribed using SR and AR, respectively (95% CI, 45.7–56.3; P = 0.86). There were no differences in demographic or vision characteristics between participants with different preferences (P > 0.05 for all). Conclusions: We observed a strong agreement between the prescriptions from SR and AR, and eyeglasses prescribed using SR and AR were equally preferred by patients. Wider use of prescribing based on AR alone in resource-limited settings is supported by these finding

Pathological investigations of Vibrio vulnificus infection in Genetically Improved Farmed Tilapia (Oreochromis niloticus L.) cultured at a floating cage farm of India

An outbreak of skin ulcers with morbidity and mortality rate of 80% and 20% respectively, among Genetically Improved Farmed Tilapia (GIFT) sub-adults reared in a brackish water floating cage farm of Kochi, Kerala, India was reported. Bacterial isolation attempts from various internal organs (blood, kidney, liver, spleen and brain) of different diseased fish indicated a common bacterial etiology. Organisms were identified as Vibrio vulnificus based on conventional microbiological methods followed by molecular confirmation. Additionally, V. vulnificus marker specific for fish virulence was present in the isolates. Fish pathogenicity was confirmed by challenge tests. LD50 was calculated as 2.1 × 105.13 CFU/fish and 2.1 × 106.12 CFU/mL in injection and immersion route respectively. pilF polymorphism-based PCR and vvhA gene sequence indicated potential danger for humans. The strain was positive for siderophore, hemolysin, capsule, polar and lateral flagella. The strain could multiply rapidly in healthy fish serum. All these results indicated that the isolate could act as a primary pathogen for tilapia fish. Interestingly, serum survival ratio of the pathogen was significantly larger at higher temperatures (p ≤ .05); which may explain the increase in infective capacity of V. vulnificus at higher temperature. Multiple antibiotic resistance index of the strain was ≤0.2. In conclusion, the paper provides detailed descriptions of clinical signs, microscopic and macroscopic lesions of a natural disease outbreak among tilapia raised in brackish water cage farms of India. The concurrent attempts to identify and characterize the etiology fetches the basis for future development of effective control and preventive measures against V. vulnificus, the most infectious and lethal of all zoonotic vibrios

Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial.

Importance: Evidence regarding corticosteroid use for severe coronavirus disease 2019 (COVID-19) is limited. Objective: To determine whether hydrocortisone improves outcome for patients with severe COVID-19. Design, Setting, and Participants: An ongoing adaptive platform trial testing multiple interventions within multiple therapeutic domains, for example, antiviral agents, corticosteroids, or immunoglobulin. Between March 9 and June 17, 2020, 614 adult patients with suspected or confirmed COVID-19 were enrolled and randomized within at least 1 domain following admission to an intensive care unit (ICU) for respiratory or cardiovascular organ support at 121 sites in 8 countries. Of these, 403 were randomized to open-label interventions within the corticosteroid domain. The domain was halted after results from another trial were released. Follow-up ended August 12, 2020. Interventions: The corticosteroid domain randomized participants to a fixed 7-day course of intravenous hydrocortisone (50 mg or 100 mg every 6 hours) (n = 143), a shock-dependent course (50 mg every 6 hours when shock was clinically evident) (n = 152), or no hydrocortisone (n = 108). Main Outcomes and Measures: The primary end point was organ support-free days (days alive and free of ICU-based respiratory or cardiovascular support) within 21 days, where patients who died were assigned -1 day. The primary analysis was a bayesian cumulative logistic model that included all patients enrolled with severe COVID-19, adjusting for age, sex, site, region, time, assignment to interventions within other domains, and domain and intervention eligibility. Superiority was defined as the posterior probability of an odds ratio greater than 1 (threshold for trial conclusion of superiority >99%). Results: After excluding 19 participants who withdrew consent, there were 384 patients (mean age, 60 years; 29% female) randomized to the fixed-dose (n = 137), shock-dependent (n = 146), and no (n = 101) hydrocortisone groups; 379 (99%) completed the study and were included in the analysis. The mean age for the 3 groups ranged between 59.5 and 60.4 years; most patients were male (range, 70.6%-71.5%); mean body mass index ranged between 29.7 and 30.9; and patients receiving mechanical ventilation ranged between 50.0% and 63.5%. For the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively, the median organ support-free days were 0 (IQR, -1 to 15), 0 (IQR, -1 to 13), and 0 (-1 to 11) days (composed of 30%, 26%, and 33% mortality rates and 11.5, 9.5, and 6 median organ support-free days among survivors). The median adjusted odds ratio and bayesian probability of superiority were 1.43 (95% credible interval, 0.91-2.27) and 93% for fixed-dose hydrocortisone, respectively, and were 1.22 (95% credible interval, 0.76-1.94) and 80% for shock-dependent hydrocortisone compared with no hydrocortisone. Serious adverse events were reported in 4 (3%), 5 (3%), and 1 (1%) patients in the fixed-dose, shock-dependent, and no hydrocortisone groups, respectively. Conclusions and Relevance: Among patients with severe COVID-19, treatment with a 7-day fixed-dose course of hydrocortisone or shock-dependent dosing of hydrocortisone, compared with no hydrocortisone, resulted in 93% and 80% probabilities of superiority with regard to the odds of improvement in organ support-free days within 21 days. However, the trial was stopped early and no treatment strategy met prespecified criteria for statistical superiority, precluding definitive conclusions. Trial Registration: ClinicalTrials.gov Identifier: NCT02735707

How Can Hospital Programs be Strengthened to Enhance Achievement of VISION 2020 Objectives?

The global initiative, “VISION 2020 – The Right to Sight” aims to eliminate avoidable blindness by year 2020. Avoidable blindness by definition are those conditions for which we already have a treatment or a surgical procedure and often a proven strategy to either prevent or cure the condition. Thus, the challenge to realize this goal would be designing the right service delivery systems specific to the local context, organizing the required resources, coordination, and implementing and monitoring these. The key “discipline” that is required to ensure successful implementation is “Management.” To be holistic, such management inputs are required both in a program as well as the hospital setting. From a program perspective, the focus will need to be on reaching the unreached, ensuring equity, creating an enabling environment, putting in place the required infrastructure, including that for developing all cadres of the eye care team, and functionally integrating eye care into the general health system and other developmental activities. From a hospital perspective, the management process should manage the internal and external ecosystems as well as all the interfaces to the hospital. It should also put in place systems for ensuring an adequate patient flow, high productivity, quality, sustainability, and accountability. Since in many countries the notion of management in health care or more specifically in eye care is at an early stage or nonexistent, a proactive effort is required to build the management capacity quickly through a structured process

Quality of eyeglass prescriptions from a low-cost wavefront autorefractor evaluated in rural India: results of a 708-participant field study

Objective To assess the quality of eyeglass prescriptions provided by an affordable wavefront autorefractor operated by a minimally trained technician in a low-resource setting. Methods and Analysis 708 participants were recruited from consecutive patients registered for routine eye examinations at Aravind Eye Hospital in Madurai, India, or an affiliated rural satellite vision centre. Visual acuity (VA) and patient preference were compared between trial lenses set to two eyeglass prescriptions from (1) a novel wavefront autorefractor and (2) subjective refraction by an experienced refractionist. Results The mean±SD VA was 0.30±0.37, –0.02±0.14 and −0.04±0.11 logarithm of the minimum angle of resolution units before correction, with autorefractor correction and with subjective refraction correction, respectively (all differences p<0.01). Overall, 25% of participants had no preference, 33% preferred eyeglass prescriptions from autorefraction, and 42% preferred eyeglass prescriptions from subjective refraction (p<0.01). Of the 438 patients 40 years old and younger, 96 had no preference and the remainder had no statistically significant difference in preference for subjective refraction prescriptions (51%) versus autorefractor prescriptions (49%) (p=0.52). Conclusion Average VAs from autorefractor-prescribed eyeglasses were one letter worse than those from subjective refraction. More than half of all participants either had no preference or preferred eyeglasses prescribed by the autorefractor. This marginal difference in quality may warrant autorefractor-based prescriptions, given the portable form factor, short measurement time, low cost and minimal training required to use the autorefractor evaluated hereThis work was financially supported by a grant from the United States–India Science & Technology Endowment Fund (USISTEF) awarded jointly to PlenOptika and Aurolab. Financial support for the initial autorefractor development is gratefully acknowledged from Comunidad de Madrid through the Madrid-MIT M+Visión Consortium. Research relating to the autorefractor reported in this publication was partially supported by the National Eye Institute of the National Institutes of Health under Award Number R43EY025452 and R44EY02545

Community Structure of Amphibians At Three Protected Areas of Kerala

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Mixed layer variability in east central Arabian Sea during premonsoon season of 1979

239-243Meteorological parameters at a station (9-degrees-N, 68-degrees-E) in the east central Arabian Sea showed the influence of a severe cyclonic storm that formed east of Sri Lanka in the first week of May 1979. One dimensional forcing functions, such as, free and forced mixing were important for regulating thermal structure in this area during the disturbed days (phase I: 2 to 14 May 1979). But, this was marginal during the calm days (phase II: 25 May to 4 June). The results of the study were utilised to model the mixed layer temperature (MLT) and mixed layer depth (MLD) following Niiler and Kraus (1977). During phase I, simulated and observed MLD and MLT matched fairly well. The differences between the observed and simulated MLT during phase II were attributed to lateral advective cooling

Variability in current and thermohaline structure off Visakhapatnam during late June 1986

232-237Subsurface currents, temperature and salinity at a station off Visakhapatnam (at 10,25,50 and 85 m), Andhra Pradesh, India are monitored for 3 d period using moored Aanderaa RCM-4 current meters. The isotherms configuration indicates upwelling and very low surface temperature ( -1). Surface layer is unstable (Ri Ri in the bottom layer indicates that the water column is always dynamically stable

Evaluation of the agreement and reliability of Transpalpebral Tonometers compared with Goldmann Applanation Tonometer – A systematic Review and Meta-Analysis Protocol

In 2020, the global prevalence of glaucoma was estimated to be 76 million and it was projected to increase to 111.8 million by 2040. Accurate intraocular pressure (IOP) measurement is imperative in glaucoma management since it is the only modifiable risk factor. Numerous studies have compared the reliability of IOP measured using transpalpebral tonometers and Goldmann applanation tonometry (GAT). This systematic review and meta-analysis aims to update the existing literature with a reliability and agreement comparison of transpalpebral tonometers against the gold standard GAT for IOP measurement among individuals presenting for ophthalmic examinations. The data collection will be performed using a predefined search strategy through electronic databases. Prospective methods-comparison studies published between January 2000 and September 2022 will be included. Studies will be deemed eligible if they report empirical findings on the agreement between transpalpebral tonometry and Goldmann applanation tonometry. The standard deviation and limits of agreement between each study and their pooled estimate along with weights and percentage of error will be reported using a forest plot. Cochrane's Q test and the I2 statistic will be used to assess heterogeneity, and the publication bias will be investigated using a funnel plot, Begg's and Egger's tests. The review results will provide additional evidence on the reliability of transpalpebral tonometers that, in turn, could possibly assist practitioners to make informed decision about using it as a screening or diagnostic device for clinical practice, outreach camps, or home-based screening. Institutional Ethics Committee registration number: RET202200390. PROSPERO Registration Number: CRD42022321693