Functional improvement after one- and two-eye cataract surgery in the salisbury eye evaluation

Purpose: To determine the impact that cataract and cataract surgery have on clinical measurements of vision, reading speed, objective mobility performance, and subjective visual functioning. Design: Prospective, population-based study. Participants: A total of 1739 Salisbury Eye Evaluation (SEE) participants without previous cataract surgery with bilateral baseline best-corrected visual acuity (BCVA) of logarithm of the minimum angle of resolution (logMAR) ≤0.3 (≥20/40) or cataract surgery between rounds 1 and 2. Methods: Participants were categorized on the basis of cataract surgery by round 2 into no surgery, unilateral surgery, or bilateral surgery. Visual performance, mobility-based tasks, and the Activities of Daily Vision Scale (ADVS) were measured at baseline and 2 years. Mobility score was converted into a z score by subtracting the participant's time from the population baseline average and then dividing by the standard deviation. Comparisons were made between the no surgery and surgery groups using multivariate linear regression. Main Outcome Measures: Change in bilateral BCVA in logMAR, contrast sensitivity, reading speed in words per minute (wpm), mobility score, and ADVS. Results: During the study period, 29 participants had cataract surgery on both eyes, 90 participants had unilateral surgery, and 1620 participants had no surgery. After adjusting for baseline value, demographics, depression, and mental status, the unilateral surgery group's BCVA improved 0.04 logMAR (P = 0.001) and the bilateral group's BCVA improved 0.13 compared with no surgery (P<0.001). Overall mobility declined in all groups. The unilateral group's z score decreased 0.18 more than that of the no surgery group (P = 0.02), whereas the bilateral group showed a 0.18 z score improvement compared with no surgery (P = 0.19). Change in reading speed significantly improved in the unilateral and bilateral groups compared with no surgery (12 and 31 wpm, respectively). The bilateral surgery group showed significant positive change in ADVS compared with no surgery (5 points of relative improvement; P = 0.01), whereas the unilateral group showed a 5-point relative decline (P<0.001). Conclusions: Cataract negatively affects both subjective quality of life and objective performance measures. Unilateral cataract surgery improves visual functioning, but the largest gains are found in patients who undergo second-eye cataract surgery. This finding supports second-eye cataract surgery for patients with visual or functional symptoms even after successful first-eye surgery

Association between Nutritional Status and Positive Childhood Disability Screening Using the Ten Questions Plus Tool in Sarlahi, Nepal

The study was conducted to examine the association between the indicators of malnutrition and disability of children as reported by caregivers. The Ten Questions Plus questionnaire was administered to caregivers of 1,902 children aged 1–9 years, during August 2007–March 2008, in rural Nepal. Height and weight of children were also measured. The main outcome was a positive response to one or more questions. In total, 514 (27%) children had a positive response to at least one question. Moderate stunting [odds ratio (OR)=1.47, 95% confidence interval (CI) 1.02–2.12) and severe (OR=2.39, 95% CI 1.60–3.57) stunting were independently associated with reported delay in sitting, standing, or walking. Severe stunting was also associated with report of delayed learning compared to other children of similar age (OR=2.01, 95% CI 1.27–3.20). Parental report of disability was quite prevalent in this setting, with over a quarter of the sample screening positive. Chronic malnutrition may be associated with delayed motor and mental development

Visual characteristics of elderly night drivers in the Salisbury Eye Evaluation Driving Study

PURPOSE. To characterize visual factors among those who continue to drive and those who restrict night driving in the elderly population. METHODS. The Salisbury Eye Evaluation Driving Study (SEEDS) is a study of vision, cognition, and driving behaviors of older drivers living in the greater Salisbury, Maryland, metropolitan area. Patients were recruited from listings in the Department of Motor Vehicle Administration. Data are reported from two visits conducted 2 years apart. Night driving was assessed using a real-time driving assessment tool, the Driving Monitor System. Night driving was defined by the presence of at least one episode of driving at night during a 5-day time period (seasonally adjusted). Participants also underwent a battery of cognitive and visual function testing including distance acuity, contrast sensitivity, and visual fields. Logistic regression was used to model factors associated with night driving. RESULTS. Complete data were available for 990 of the 1080 participants (92%) attending both visits; 41% of participants were driving at night in each visit. Those who were younger (P < 0.001), male (P < 0.001), and had better measures of cognitive (P 1/4 0.007) and visual function were observed driving at night, whereas those who were older, female, and had poorer measures of cognitive and visual function restricted their night driving behavior. An association was observed between depressive symptoms and less night driving in females (P 1/4 0.003). In multivariate analysis, better contrast sensitivity (odds ratio [OR] 1.18, 95% confidence interval [CI] 1.02-1.36, P 1/4 0.02) and visual field detection (OR 1.21, 95% CI 1.00-1.47, P 1/4 0.05) were associated with driving at night. Visual acuity was not found to be significantly related to night driving (OR 1.08, 95% CI 0.95-1.18, P 1/4 0.12). CONCLUSIONS. Restricting driving at night is a multifactorial behavior that has a vision component, notably poor contrast sensitivity, and some loss of visual fields

Definitions and standardization of a new grading scheme for eyelid contour abnormalities after trichiasis surgery

Background: Clear definitions of outcomes following trichiasis surgery are critical for planning program evaluations and for identifying ways to improve trichiasis surgery. Eyelid contour abnormality is an important adverse outcome of surgery; however, no standard method has been described to categorize eyelid contour abnormalities. Methodology/Principal Findings: A classification system for eyelid contour abnormalities following surgery for trachomatous trichiasis was developed. To determine whether the grading was reproducible using the classification system, six-week postoperative photographs were reviewed by two senior graders to characterize severity of contour abnormalities. Sample photographs defining each contour abnormality category were compiled and used to train four new graders. All six graders independently graded a Standardization Set of 75 eyelids, which included a roughly equal distribution across the severity scale, and weighted kappa scores were calculated. Two hundred forty six-week postoperative photographs from an ongoing clinical trial were randomly selected for evaluating agreement across graders. Two months after initial grading, one grader regraded a subset of the 240 photographs to measure longer-term intra-observer agreement. The weighted kappa for agreement between the two senior graders was 0.80 (95% CI: 0.71-0.89). Among the Standardization Set, agreement between the senior graders and the 4 new graders showed weighted kappa scores ranging from 0.60-0.80. Among 240 eyes comprising the clinical trial dataset, agreement ranged from weighted kappa 0.70-0.71. Longer-term intra-observer agreement was weighted kappa 0.86 (95% CI: 0.80-0.92). Conclusions/Significance: The standard eyelid contour grading system we developed reproducibly delineates differing levels of contour abnormality. This grading system could be useful both for helping to evaluate trichiasis surgery outcomes in clinical trials and for evaluating trichiasis surgery programs

Relationship between immediate post-operative appearance and 6-week operative outcome in trichiasis surgery

Background: Surgical technique, including suture placement and tension, is believed to contribute to the outcome of bilamellar tarsal rotation surgery for trachomatous trichiasis. However, the immediate post-operative appearance that minimizes the chance of recurrence and other adverse outcomes has not been investigated. Methodology/Principal Findings: To explore whether the degree of correction immediately after surgery is predictive of surgical outcome at the 6-week post-operative visit, photographs taken immediately after surgery were used to predict surgical outcomes, including the severity of eyelid contour abnormality and trichiasis recurrence. Both eyelid contour abnormalities and recurrence were accurately predicted from the immediate post-operative photographs by an experienced oculoplastic surgeon 85% and 70% of the time, respectively. Participants with a "slight over-correction" that resulted in no eyelid contour abnormality and no recurrence were used to identify immediate post-operative contours that lead to a successful surgical outcome. Conclusions/Significance: The immediate post-operative eyelid contour is an important indicator of post-operative success of BLTR surgery. Based upon our findings, we developed a Surgery Photocard. This card illustrates some examples of immediate post-surgical appearances, which led to a successful outcome, as well as sub-optimal appearances, which led to poor surgical outcomes. The card also provides suggestions for improving the appearance by adjusting the suture placement or tension based upon standard oculoplastic principles

Magnetic breakdown and Landau level spectra of a tunable double-quantum-well Fermi surface

By measuring longitudinal resistance, the authors map the Landau level spectra of double quantum wells as a function of both parallel (B{sub {parallel}}) and perpendicular (B{sub {perpendicular}}) magnetic fields. In this continuously tunable highly non-parabolic system, the cyclotron masses of the two Fermi surface orbits change in opposite directions with B{sub {parallel}}. This causes the two corresponding ladders of Landau levels formed at finite B{sub {perpendicular}} to exhibit multiple crossings. They also observe a third set of landau levels, independent of B{sub {parallel}}, which arise from magnetic breakdown of the Fermi surface. Both semiclassical and full quantum mechanical calculations show good agreement with the data

Impact of trichiasis surgery on physical functioning in Ethiopian patients: Star trial

Purpose To evaluate the physical functioning of Ethiopian trichiasis surgery patients before and 6 months after surgery. Design Nested cohort study. Methods This study was nested within the Surgery for Trichiasis, Antibiotics to Prevent Recurrence (STAR) clinical trial conducted in Ethiopia. Demographic information, ocular examinations, and physical functioning assessments were collected before and 6 months after surgery. A single score for patients' physical functioning was constructed using Rasch analysis. A multivariate linear regression model was used to determine if change in physical functioning was associated with change in visual acuity. Results Of the 438 participants, 411 (93.8%) had both baseline and follow-up questionnaires. Physical functioning scores at baseline ranged from -6.32 (great difficulty) to +6.01 (no difficulty). The percentage of participants reporting no difficulty in physical functioning increased by 32.6%; the proportion of participants in the mild/no visual impairment category increased by 8.6%. A multivariate linear regression model showed that for every line of vision gained, physical functioning improves significantly (0.09 units; 95% CI: 0.020.16). Conclusions Surgery to correct trichiasis appears to improve patients' physical functioning as measured at 6 months. More effort in promoting trichiasis surgery is essential, not only to prevent corneal blindness, but also to enable improved functioning in daily life

Slavnov-Taylor identities in Coulomb gauge Yang-Mills theory

The Slavnov-Taylor identities of Coulomb gauge Yang-Mills theory are derived from the (standard, second order) functional formalism. It is shown how these identities form closed sets from which one can in principle fully determine the Green's functions involving the temporal component of the gauge field without approximation, given appropriate input.Comment: 20 pages, no figure

Methotrexate promotes platelet apoptosis via JNK-mediated mitochondrial damage: Alleviation by N-acetylcysteine and N-acetylcysteine amide

Thrombocytopenia in methotrexate (MTX)-treated cancer and rheumatoid arthritis (RA) patients connotes the interference of MTX with platelets. Hence, it seemed appealing to appraise the effect of MTX on platelets. Thereby, the mechanism of action of MTX on platelets was dissected. MTX (10 μM) induced activation of pro-apoptotic proteins Bid, Bax and Bad through JNK phosphorylation leading to Îm dissipation, cytochrome c release and caspase activation, culminating in apoptosis. The use of specific inhibitor for JNK abrogates the MTX-induced activation of pro-apoptotic proteins and downstream events confirming JNK phosphorylation by MTX as a key event. We also demonstrate that platelet mitochondria as prime sources of ROS which plays a central role in MTX-induced apoptosis. Further, MTX induces oxidative stress by altering the levels of ROS and glutathione cycle. In parallel, the clinically approved thiol antioxidant N-acetylcysteine (NAC) and its derivative N-acetylcysteine amide (NACA) proficiently alleviate MTX-induced platelet apoptosis and oxidative damage. These findings underpin the dearth of research on interference of therapeutic drugs with platelets, despite their importance in human health and disease. Therefore, the use of antioxidants as supplementary therapy seems to be a safe bet in pathologies associated with altered platelet functions. © 2015 Paul et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

Biological anthropology in the Indo-Pacific Region: New approaches to age-old questions

Biological anthropological research, the study of both modern and past humans, is a burgeoning field in the Indo-Pacific region. It is becoming increasingly apparent that the unique environments of the Indo-Pacific have resulted in an archaeological record that does not necessarily align with those in the northern hemisphere. New, regionally-specific archaeological models are being developed, and biological anthropological research has an important role to play in establishing past human experience within these models. In the Indo-Pacific, research using ancient and modern human tissues is adding insight into global processes of prehistoric settlement and migrations, subsistence change and human biosocial adaptation. This review synthesises current themes in biological anthropology in this region. It highlights the diverse methods and approaches used by biological anthropologists to address globally-relevant archaeological questions. In recent decades a collaborative approach between archaeologists, biological anthropologists and local communities has become the norm in the region. The many positive outcomes of this multi-disciplinary approach are highlighted here through the use of regionally-specific case studies. This review ultimately aims to stimulate further collaborations between archaeologists, biological anthropologists and the communities in the region, and demonstrate how the evidence from Indo-Pacific research may be relevant to global archaeological models