Demand-side financing: can it help deliver eye care for all?

Demand-side financing mechanisms in eye care can be a tool to achieve universal eye health coverage by increasing access and utilisation of key eye health services

Community involvement in eye care: a health systems perspective.

Active community participation in the six pillars of the health systems strengthening framework is vital if we are to achieve universal access to eye care

Common variants in SOX-2 and congenital cataract genes contribute to age-related nuclear cataract

Nuclear cataract is the most common type of age-related cataract and a leading cause of blindness worldwide. Age-related nuclear cataract is heritable (h2 = 0.48), but little is known about specific genetic factors underlying this condition. Here we report findings from the largest to date multi-ethnic meta-analysis of genome-wide association studies (discovery cohort N = 14,151 and replication N = 5299) of the International Cataract Genetics Consortium. We confirmed the known genetic association of CRYAA (rs7278468, P = 2.8 × 10−16) with nuclear cataract and identified five new loci associated with this disease: SOX2-OT (rs9842371, P = 1.7 × 1

Grand Challenges in global eye health: a global prioritisation process using Delphi method

Background We undertook a Grand Challenges in Global Eye Health prioritisation exercise to identify the key issues that must be addressed to improve eye health in the context of an ageing population, to eliminate persistent inequities in health-care access, and to mitigate widespread resource limitations. Methods Drawing on methods used in previous Grand Challenges studies, we used a multi-step recruitment strategy to assemble a diverse panel of individuals from a range of disciplines relevant to global eye health from all regions globally to participate in a three-round, online, Delphi-like, prioritisation process to nominate and rank challenges in global eye health. Through this process, we developed both global and regional priority lists. Findings Between Sept 1 and Dec 12, 2019, 470 individuals complete round 1 of the process, of whom 336 completed all three rounds (round 2 between Feb 26 and March 18, 2020, and round 3 between April 2 and April 25, 2020) 156 (46%) of 336 were women, 180 (54%) were men. The proportion of participants who worked in each region ranged from 104 (31%) in sub-Saharan Africa to 21 (6%) in central Europe, eastern Europe, and in central Asia. Of 85 unique challenges identified after round 1, 16 challenges were prioritised at the global level; six focused on detection and treatment of conditions (cataract, refractive error, glaucoma, diabetic retinopathy, services for children and screening for early detection), two focused on addressing shortages in human resource capacity, five on other health service and policy factors (including strengthening policies, integration, health information systems, and budget allocation), and three on improving access to care and promoting equity. Interpretation This list of Grand Challenges serves as a starting point for immediate action by funders to guide investment in research and innovation in eye health. It challenges researchers, clinicians, and policy makers to build collaborations to address specific challenge

Multichannel delivery in healthcare: the impact of telemedicine centres in Southern India

Telemedicine is increasingly used across the developing world to expand access to healthcare, to improve outcomes, and to reduce costs. One common model is that of telemedicine centers, which are small primary care facilities run by midlevel (nonphysician) providers who conduct a preliminary examination and then facilitate a telemedicine visit with a remote physician in real time. However, the impact of this channel of care delivery — particularly on existing physical healthcare-delivery channels — has not been thoroughly examined. We use data from one of the largest tele-ophthalmology implementations in the world to examine this issue. Using a quasi-experimental difference-in-differences approach, we find that opening a nearby telemedicine center generates a 31% increase in the overall network visit rate from the population within 10 km of the new center, 62% of which is driven by new patients, suggesting a substantial increase in access. The rate of eyeglasses prescriptions to correct for simple refractive errors increases by 18.5%, whereas the rate of cataract surgery to replace the natural lens in a patient’s eye with an artificial lens remains unchanged. The increase in access and treatment rates does not significantly impact the direct costs incurred by patients, but reduces their indirect costs (measured as travel distance) by 30% (12 km). Finally, we find significant spatial heterogeneity in these effects, which vary with the distance of patients to facilities. These results have important implications for the design of telemedicine networks and the portfolio of healthcare services provided through them

Regulated phosphorylation of the K-Cl cotransporter KCC3 is a molecular switch of intracellular potassium content and cell volume homeostasis

The defense of cell volume against excessive shrinkage or swelling is a requirement for cell function and organismal survival. Cell swelling triggers a coordinated homeostatic response termed regulatory volume decrease (RVD), resulting in K+ and Cl− efflux via activation of K+ channels, volume-regulated anion channels (VRACs), and the K+-Cl− cotransporters, including KCC3. Here, we show genetic alanine (Ala) substitution at threonines (Thr) 991 and 1048 in the KCC3a isoform carboxyl-terminus, preventing inhibitory phosphorylation at these sites, not only significantly up-regulates KCC3a activity up to 25-fold in normally inhibitory isotonic conditions, but is also accompanied by reversal of activity of the related bumetanide-sensitive Na+-K+-2Cl− cotransporter isoform 1 (NKCC1). This results in a rapid (90%) reduction in intracellular K+ content (Ki) via both Cl-dependent (KCC3a + NKCC1) and Cl-independent [DCPIB (VRAC inhibitor)-sensitive] pathways, which collectively renders cells less prone to acute swelling in hypotonic osmotic stress. Together, these data demonstrate the phosphorylation state of Thr991/Thr1048 in KCC3a encodes a potent switch of transporter activity, Ki homeostasis, and cell volume regulation, and reveal novel observations into the functional interaction among ion transport molecules involved in RVD

Regulated phosphorylation of the K-Cl cotransporter KCC3 at dual C-terminal threonines is a potent switch of intracellular potassium content and cell volume homeostasis

The defense of cell volume against excessive shrinkage or swelling is a requirement for cell function and organismal survival. Cell swelling triggers a coordinated homeostatic response termed regulatory volume decrease (RVD), resulting in K+ and Cl– efflux via the activation of K+ channels, volume-regulated anion channels (VRACs), and the K+-Cl– cotransporters, including KCC3. Here, we show genetic alanine (Ala) substitution at threonines (Thr) 991 and 1048 in the KCC3a isoform carboxyl-terminus, preventing inhibitory phosphorylation at these sites, not only significantly up-regulates KCC3a activity up to 25-fold in normally inhibitory isotonic conditions, but is also accompanied by reversal of activity of the related bumetanide-sensitive Na+-K+-2Cl– cotransporter isoform 1 (NKCC1). This results in a rapid (90 %) reduction in intracellular K+ content (Ki) via both Cl-dependent (KCC3a + NKCC1) and Cl-independent (DCPIB [VRAC inhibitor]-sensitive) pathways, which collectively renders cells less prone to acute swelling in hypotonic osmotic stress. Together, these data demonstrate the phosphorylation state of Thr991/Thr1048 in the KCC3a encodes a potent switch of transporter activity, Ki homeostasis, and cell volume regulation, and reveal novel observations into the functional interaction among ion transport molecules involved in RVD

Enhancing Liquid-Phase Olefin-Paraffin Separations Using Novel Silver-Based Ionic Liquids

This paper describes the extraction of C5–C8 linear α-olefins from olefin/paraffin mixtures of the same carbon number using silver­(I)/<i>N,N</i>-dimethylbenzamide bis­(trifluoromethylsulfonyl)­imide ([Ag­(DMBA)₂]­[Tf₂N]) or silver­(I)/propylamine bis­(trifluoromethylsulfonyl)­imide ([Ag­(PrNH₂)₂]­[Tf₂N]) as the extracting agent. The separation performance of the system increased with increasing chain length. [Ag­(DMBA)₂]­[Tf₂N] appeared to outperform [Ag­(PrNH₂)₂]­[Tf₂N] in terms of both selectivity and distribution coefficient. The [Ag­(DMBA)₂]­[Tf₂N] system was successfully modeled using the universal quasi-chemical activity coefficient (UNIQUAC) model. These results support the potential future development of amine/amide-based ligands for producing soluble silver complexes useful for the separation of olefins from paraffins