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Williams GA, Ziemann M, Chen C, Forman R, Sagan A, Pittman P. Global health workforce strategies to address the COVID-19 pandemic: Learning lessons for the future. Int J Health Plann Manage 2024; 39:888-897. [PMID: 38233974 DOI: 10.1002/hpm.3762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 12/28/2023] [Indexed: 01/19/2024] Open
Abstract
COVID-19 put unprecedented strain on the health and care workforce (HCWF). Yet, it also brought the HCWF to the forefront of the policy agenda and revealed many innovative solutions that can be built upon to overcome persistent workforce challenges. In this perspective, which draws on a Policy Brief prepared for the WHO Fifth Global Forum on Human Resources for Health, we present findings from a scoping review of global emergency workforce strategies implemented during the pandemic and consider what we can learn from them for the long-term sustainability of the HCWF. Our review shows that strategies to strengthen HCWF capacity during COVID-19 fell into three categories: (1) surging supply of health and care workers (HCWs); (2) optimizing the use of the workforce in terms of setting, skills and roles; and (3) providing HCWs with support and protection. While some initiatives were only short-term strategies, others have potential to be continued. COVID-19 demonstrated that changes to scope-of-practice and the introduction of team-based roles are possible and central to an effective, sustainable workforce. Additionally, the use of technology and digital tools increased rapidly during COVID-19 and can be built on to enhance access and efficiency. The pandemic also highlighted the importance of prioritizing the security, safety, and physical and mental health of workers, implementing measures that are gender and equity-focused, and ensuring the centrality of the worker perspective in efforts to improve HCWF retention. Flexibility of regulatory, financial, technical measures and quality assurance was critical in facilitating the implementation of HCWF strategies and needs to be continued. The lessons learned from COVID-19 can help countries strengthen the HCWF, health systems, and the health and well-being of all, now and in the future.
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Affiliation(s)
- Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - Margaret Ziemann
- Department of Health Policy & Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Candice Chen
- Department of Health Policy & Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Rebecca Forman
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - Anna Sagan
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - Patricia Pittman
- Department of Health Policy & Management, Fitzhugh Mullan Institute for Health Workforce Equity, Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
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McPake B, Dayal P, Zimmermann J, Williams GA. How can countries respond to the health and care workforce crisis? Insights from international evidence. Int J Health Plann Manage 2024; 39:879-887. [PMID: 38278780 DOI: 10.1002/hpm.3766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/02/2024] [Accepted: 01/06/2024] [Indexed: 01/28/2024] Open
Abstract
Future global health security requires a health and care workforce (HCWF) that can respond effectively to health crises as well as to changing health needs with ageing populations, a rise in chronic conditions and growing inequality. COVID-19 has drawn attention to an impending HCWF crisis with a large projected shortfall in numbers against need. Addressing this requires countries to move beyond a focus on numbers of doctors, nurses and midwives to consider what kinds of healthcare workers can deliver the services needed; are more likely to stay in country, in rural and remote areas, and in health sector jobs; and what support they need to deliver high-quality services. In this paper, which draws on a Policy Brief prepared for the World Health Organization (WHO) Fifth Global Forum on Human Resources for Health, we review the global evidence on best practices in organising, training, deploying, and managing the HCWF to highlight areas for strategic investments. These include (1). Increasing HCWF diversity to improve the skill-mix and provide culturally competent care; (2). Introducing multidisciplinary teams in primary care; (3). Transforming health professional education with greater interprofessional education; (4). Re-thinking employment and deployment systems to address HCWF shortages; (5). Improving HCWF retention by supporting healthcare workers and addressing migration through destination country policies that limit draining resources from countries with greatest need. These approaches are departures from current norms and hold substantial potential for building a sustainable and responsive HCWF.
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Affiliation(s)
- Barbara McPake
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Prarthna Dayal
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia Zimmermann
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
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Scarpetti G, Shadowen H, Williams GA, Winkelmann J, Kroneman M, Groenewegen PP, De Jong JD, Fronteira I, Augusto GF, Hsiung S, Slade S, Rojatz D, Kallayova D, Katreniakova Z, Nagyova I, Kylänen M, Vracko P, Jesurasa A, Wallace Z, Wallace C, Costongs C, Barnes AJ, van Ginneken E. A comparison of social prescribing approaches across twelve high-income countries. Health Policy 2024; 142:104992. [PMID: 38368661 DOI: 10.1016/j.healthpol.2024.104992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 12/06/2023] [Accepted: 01/08/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Social prescribing connects patients with community resources to improve their health and well-being. It is gaining momentum globally due to its potential for addressing non-medical causes of illness while building on existing resources and enhancing overall health at a relatively low cost. The COVID-19 pandemic further underscored the need for policy interventions to address health-related social issues such as loneliness and isolation. AIM This paper presents evidence of the conceptualisation and implementation of social prescribing schemes in twelve countries: Australia, Austria, Canada, England, Finland, Germany, Portugal, the Slovak Republic, Slovenia, the Netherlands, the United States and Wales. METHODS Twelve countries were identified through the Health Systems and Policy Monitor (HSPM) network and the EuroHealthNet Partnership. Information was collected through a twelve open-ended question survey based on a conceptual model inspired by the WHO's Health System Framework. RESULTS We found that social prescribing can take different forms, and the scale of implementation also varies significantly. Robust evidence on impact is scarce and highly context-specific, with some indications of cost-effectiveness and positive impact on well-being. CONCLUSIONS This paper provides insights into social prescribing in various contexts and may guide countries interested in holistically tackling health-related social factors and strengthening community-based care. Policies can support a more seamless integration of social prescribing into existing care, improve collaboration among sectors and training programs for health and social care professionals.
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Affiliation(s)
- Giada Scarpetti
- Technische Universität Berlin, European Observatory on Health Systems and Policies.
| | | | - Gemma A Williams
- European Observatory on Health Systems and Policies, World Health Organization
| | - Juliane Winkelmann
- European Observatory on Health Systems and Policies, World Health Organization
| | - Madelon Kroneman
- Nivel (Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Peter P Groenewegen
- Nivel (Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Judith D De Jong
- Nivel (Netherlands Institute for Health Services Research, Utrecht, Netherlands and Maastricht University
| | - Inês Fronteira
- Global Health and Tropical, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Gonçalo Figueiredo Augusto
- Comprehensive Health Research Center (CHRC), Escola Nacional de Saúde Pública (ENSP), Universidade NOVA de Lisboa (UNL), Lisboa, Portugal
| | - Sonia Hsiung
- Canadian Institute for Social Prescribing, Canadian Red Cross
| | - Siân Slade
- Nossal Institute for Global Health, University of Melbourne, Australia
| | - Daniela Rojatz
- Austrian National Public Health Institute, Vienna, Austria
| | - Daniela Kallayova
- Ministry of Health of the Slovak Republic, Bratislava, Slovak Republic
| | - Zuzana Katreniakova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice and Slovak Public Health Association (SAVEZ), Kosice, Slovak Republic
| | - Iveta Nagyova
- Department of Social and Behavioural Medicine, Faculty of Medicine, PJ Safarik University in Kosice and Slovak Public Health Association (SAVEZ), Kosice, Slovak Republic
| | - Marika Kylänen
- Finnish Best Practice Portal for Health and Wellbeing Promotion, Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Pia Vracko
- National Institute of Public Health, Ljubljana, Slovenia
| | | | | | - Carolyn Wallace
- University of South Wales, Wales School for Social Prescribing Research (WSSPR), UK
| | | | | | - Ewout van Ginneken
- Technische Universität Berlin, European Observatory on Health Systems and Policies
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Maier CB, Winkelmann J, Pfirter L, Williams GA. Skill-Mix Changes Targeting Health Promotion and Prevention Interventions and Effects on Outcomes in all Settings (Except Hospitals): Overview of Reviews. Int J Public Health 2023; 68:1605448. [PMID: 37228895 PMCID: PMC10203245 DOI: 10.3389/ijph.2023.1605448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Accepted: 04/14/2023] [Indexed: 05/27/2023] Open
Abstract
Objectives: Skill-mix changes to step up health promotion and prevention are increasing, but there is limited evidence on their effects. Methods: Overview of reviews, based on a protocol. The search was carried out in six databases, screening was performed ensuring high interrater reliability. All countries, health professions and lay workers in all settings (except hospitals) were included, quality appraisals performed. Results: A total of 31 systematic reviews were included. Expanded roles performing outreach (e.g., home visits) had mostly positive effects on access and health outcomes, primarily for hard-to-reach groups. Task-shifting in colorectal or skin cancer screenings (performed by advanced practice nurses) were suggested effective; supporting roles (by community health workers) increased uptake in screenings, but based on limited evidence. Expanded roles of various professions focusing on lifestyle modification showed promising effects in most reviews, including weight, diet, smoking cessation and physical activity. Reviews on cost-effectiveness were based on limited evidence. Conclusion: Promising skill-mix changes included expanded roles providing lifestyle modifying interventions, task-shifting, and outreach roles for hard-to-reach groups, whereas evidence on costs was limited.
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Affiliation(s)
- Claudia Bettina Maier
- Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany
| | | | - Laura Pfirter
- Department of Health Care Management, Faculty of Economics and Management, Technical University Berlin, Berlin, Germany
| | - Gemma A. Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, United Kingdom
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Maoz Breuer R, Waitzberg R, Breuer A, Cram P, Bryndova L, Williams GA, Kasekamp K, Keskimaki I, Tynkkynen LK, van Ginneken V, Kovács E, Burke S, McGlacken-Byrne D, Norton C, Whiston B, Behmane D, Grike I, Batenburg R, Albreh T, Pribakovic R, Bernal-Delgado E, Estupiñan-Romero F, Angulo-Pueyo E, Rose AJ. Work like a Doc: A comparison of regulations on residents' working hours in 14 high-income countries. Health Policy 2023; 130:104753. [PMID: 36827717 DOI: 10.1016/j.healthpol.2023.104753] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/13/2023] [Accepted: 02/15/2023] [Indexed: 02/21/2023]
Abstract
BACKGROUND Medical residents work long, continuous hours. Working in conditions of extreme fatigue has adverse effects on the quality and safety of care, and on residents' quality of life. Many countries have attempted to regulate residents' work hours. OBJECTIVES We aimed to review residents' work hours regulations in different countries with an emphasis on night shifts. METHODS Standardized qualitative data on residents' working hours were collected with the assistance of experts from 14 high-income countries through a questionnaire. An international comparative analysis was performed. RESULTS All countries reviewed limit the weekly working hours; North-American countries limit to 60-80 h, European countries limit to 48 h. In most countries, residents work 24 or 26 consecutive hours, but the number of long overnight shifts varies, ranging from two to ten. Many European countries face difficulties in complying with the weekly hour limit and allow opt-out contracts to exceed it. CONCLUSIONS In the countries analyzed, residents still work long hours. Attempts to limit the shift length or the weekly working hours resulted in modest improvements in residents' quality of life with mixed effects on quality of care and residents' education.
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Affiliation(s)
- Rina Maoz Breuer
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel
| | - Ruth Waitzberg
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; Department of Health Care Management, Faculty of Economics & Management, Technical University Berlin, Germany.
| | - Adin Breuer
- Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Peter Cram
- Institute for Health Policy, Management, and Evaluation, University of Toronto, Canada
| | - Lucie Bryndova
- Center for Social and Economic Strategies, Faculty of Social Sciences, Charles University, Czechia
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London United Kingdom
| | | | | | - Liina-Kaisa Tynkkynen
- Faculty of Social Sciences, Tampere University, Finland; Welfare State Research and Reform, Finnish Institute for Health and Welfare, Finland
| | - Verena van Ginneken
- Department of Psychiatry, Campus Benjamin Franklin, Charité - Universitätsmedizin, Germany
| | - Eszter Kovács
- Health Workforce Planning Knowledge Centre, Semmelweis University, Hungary
| | - Sara Burke
- Centre for Health Policy and Management, Trinity College Dublin, Ireland
| | | | | | | | - Daiga Behmane
- Faculty of Public Health and Social Welfare, Riga Stradins University, Latvia
| | - Ieva Grike
- Faculty of Residency Manager of Residency study process Riga Stradins University, Latvia
| | - Ronald Batenburg
- Netherlands institute for Health Services Research (Nivel), Radboud University Nijmegen, Faculty of Social Sciences, the Netherlands
| | - Tit Albreh
- Centre for Health Care National Institute of Public Health Trubarjeva, Slovenia
| | - Rade Pribakovic
- Centre for Health Care at the National Institute of Public Health of Slovenia, Slovenia
| | | | | | | | - Adam J Rose
- The Smokler Center for Health Policy Research, Myers-JDC-Brookdale Institute, Israel; School of Public Health, Hebrew University, Jerusalem, Israel
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Williams GA, Cylus J, Al Tayara L, Roubal T, Tsilaajav T, Barber SL. Can healthy ageing moderate the effects of population ageing on economic growth and health spending trends in Mongolia? A modelling study. Health Res Policy Syst 2022; 20:122. [PMID: 36443859 PMCID: PMC9706844 DOI: 10.1186/s12961-022-00916-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 09/16/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Population ageing will accelerate rapidly in Mongolia in the coming decades. We explore whether this is likely to have deleterious effects on economic growth and health spending trends and whether any adverse consequences might be moderated by ensuring better health among the older population. METHODS Fixed-effects models are used to estimate the relationship between the size of the older working-age population (55-69 years) and economic growth from 2020 to 2100 and to simulate how growth is modified by better health among the older working-age population, as measured by a 5% improvement in years lived with disability. We next use 2017 data on per capita health spending by age from the National Health Insurance Fund to project how population ageing will influence public health spending from 2020 to 2060 and how this relationship may change if the older population (≥ 60 years) ages in better or worse health than currently. RESULTS The projected increase in the share of the population aged 55-69 years is associated with a 4.1% slowdown in per-person gross domestic product (GDP) growth between 2020 and 2050 and a 5.2% slowdown from 2020 to 2100. However, a 5% reduction in disability rates among the older population offsets these effects and adds around 0.2% to annual per-person GDP growth in 2020, rising to nearly 0.4% per year by 2080. Baseline projections indicate that population ageing will increase public health spending as a share of GDP by 1.35 percentage points from 2020 to 2060; this will occur slowly, adding approximately 0.03 percentage points to the share of GDP annually. Poorer health among the older population (aged ≥ 60 years) would see population ageing add an additional 0.17 percentage points above baseline estimates, but healthy ageing would lower baseline projections by 0.18 percentage points, corresponding to potential savings of just over US$ 46 million per year by 2060. CONCLUSIONS Good health at older ages could moderate the potentially negative effects of population ageing on economic growth and health spending trends in Mongolia. Continued investment in the health of older people will improve quality of life, while also enhancing the sustainability of public budgets.
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Affiliation(s)
- Gemma A. Williams
- grid.13063.370000 0001 0789 5319European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE England ,grid.13063.370000 0001 0789 5319London School of Economics and Political Science, London, England
| | - Jonathan Cylus
- grid.13063.370000 0001 0789 5319European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE England ,grid.13063.370000 0001 0789 5319London School of Economics and Political Science, London, England ,grid.8991.90000 0004 0425 469XLondon School of Hygiene and Tropical Medicine, London, England
| | - Lynn Al Tayara
- Office for Health Systems Financing, World Health Organization, Barcelona, Spain
| | - Tomáš Roubal
- Country Office in Ukraine, World Health Organization, Kyiv, Ukraine
| | - Tsolmongerel Tsilaajav
- grid.417256.3Regional Office for South-East Asia, World Health Organization, New Delhi, India
| | - Sarah L. Barber
- Centre for Health Development, World Health Organization, Kobe, Japan
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Yankovich TL, Roberts M, Brown J, Mori Y, Williams GA, Charalambous F, Pepin S. Practical application of international recommendations and safety standards in the systematic planning and implementation of remediation of sites or areas with residual radioactive material. J Radiol Prot 2022; 42:020513. [PMID: 35551120 DOI: 10.1088/1361-6498/ac6a87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/26/2022] [Indexed: 06/15/2023]
Abstract
The IAEA fundamental safety objective is'to protect people and the environment from harmful effects of ionizing radiation'and this must be done 'without unduly limiting the operation of facilities or the conduct of activities that give rise to radiation risks', while ensuring that people and the environment, present and future are protected against radiation risks (IAEA 2006Fundamental Safety Principles, Safety FundamentalsNo. SF-1). In addition,'protective actions to reduce existing or unregulated radiation risks must be justified and optimized'(IAEA 2006Fundamental Safety Principles, Safety FundamentalsNo. SF-1). An international system of radiological protection can be applied such that processes, such as remediation, can be systematically undertaken to address the wide range of'existing exposure situations'present globally. In doing so, decisions made regarding actions undertaken can be demonstrated to be'justified'and'optimized'(i.e. balanced), such that the amount of effort should be commensurate with the risk (applying a'graded approach'). In addition, protection of people and the environment can be demonstrated by comparing the actual exposure to appropriate criteria over the lifetime of remediation. This paper provides an overview of the current IAEA safety standards on remediation of sites or areas contaminated with residual radioactive material within the international system of radiological protection and provides practical examples of their application through case studies considered in IAEA international model validation programs.
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Affiliation(s)
- T L Yankovich
- International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria
| | - M Roberts
- International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria
| | - J Brown
- International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria
| | - Y Mori
- International Atomic Energy Agency, Vienna International Centre, PO Box 100, 1400 Vienna, Austria
| | - G A Williams
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Australia
| | - F Charalambous
- Australian Radiation Protection and Nuclear Safety Agency, Melbourne, Australia
| | - S Pepin
- Federal Agency for Nuclear Control, Brussels, Belgium
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Hui TY, Crickenberger S, Lau JWT, Williams GA. Why are "suboptimal" temperatures preferred in a tropical intertidal ectotherm? J Anim Ecol 2022; 91:1400-1415. [PMID: 35302242 DOI: 10.1111/1365-2656.13690] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 03/07/2022] [Indexed: 11/28/2022]
Abstract
In thermally extreme environments it is challenging for organisms to maximize performance due to risks associated with stochastic variation in temperature and, subsequently, over evolutionary time minimizing the exposure to risk can serve as one of the mechanisms that result in organisms preferring suboptimal temperatures. We tested this hypothesis in a slow-moving intertidal snail on tropical rocky shores, where temperature variability increases with time from 30 min to 20 h when recorded at 30 min intervals (due to short-term environmental autocorrelation where temperatures closer in time are more similar as compared to temperatures over a long period of time). Failure to accommodate temporal variation in thermal stress by selecting cool habitats can result in mortality. Thermal performance curves for different traits (heart rate and locomotion) were measured and compared to the snail's thermal preferences in both the field and laboratory. Predicted performances of the snails were simulated based on thermal performance curves for different traits over multiple time scales and simulated carryover effects. A strong mismatch was found between physiological and behavioural thermal maxima of the snails (physiological thermal maximum being higher by ~ 7 °C), but the snails avoided these maxima and sought temperatures 7 - 14 °C cooler. Such a risk-averse strategy can be explained by their predicted performances where the snails should make decisions about preferred temperatures based on time periods ≥ 5 h to avoid underestimating the temporal variation in body temperature. In extreme and stochastic environments, where the temporal variation in environmental conditions can lead to substantial divergence between instantaneous and time-averaged thermal performances, "cooler is better" and "suboptimal" body temperatures are preferred as they provide sufficient buffer to reduce mortality risk from heat stress.
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Affiliation(s)
- T Y Hui
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - S Crickenberger
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - J W T Lau
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Hong Kong, SAR, China
| | - G A Williams
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Hong Kong, SAR, China
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Budde H, Williams GA, Winkelmann J, Pfirter L, Maier CB. The role of patient navigators in ambulatory care: overview of systematic reviews. BMC Health Serv Res 2021; 21:1166. [PMID: 34706733 PMCID: PMC8555047 DOI: 10.1186/s12913-021-07140-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Accepted: 10/06/2021] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Patient navigators have been introduced across various countries to enable timely access to healthcare services and to ensure completion of diagnosis and follow-up of care. There is an increasing evidence on the the role of patient navigation for patients and healthcare systems. The aim of this study was to analyse the evidence on patient navigation interventions in ambulatory care and to evaluate their effects on individuals and health system outcomes. METHODS An overview of reviews was conducted, following a prespecified protocol. All patients in ambulatory care or transitional care setting were included in this review as long as it was related to the role of patient navigators. The study analysed patient navigators covering a wide range of health professionals such as physicians, nurses, pharmacists, social workers and lay health workers or community-based workers with no or very limited training. Studies including patient-related measures and health system-related outcomes were eligible for inclusion. A rigorous search was performed in multiple data bases. After reaching a high inter-rater agreement of 0.86, title and abstract screening was independently performed. Of an initial 14,248 search results and an additional 62 articles identified through the snowballing approach, a total of 7159 hits were eligible for title/abstract screening. 679 articles were included for full-text screening. RESULTS Eleven systematic reviews were included covering various patient navigation intervention in cancer care, disease screening, transitional care and for various chronic conditions and multimorbidity. Nine systematic reviews primarily tailored services to ethnic minorities or other disadvantaged groups. Patient navigators performed tasks such as providing education and counselling, translations, home visits, outreach, scheduling of appointments and follow-up. Eight reviews identified positive outcomes in expanding access to care, in particular for vulnerable patient groups. Two reviews on patient navigation in transitional care reported improved patient outcomes, hospital readmission rates and mixed evidence on quality of life and emergency department visits. Two reviews demonstrated improved patient outcomes for persons with various chronic conditions and multimorbidity. CONCLUSIONS Patient navigators were shown to expand access to screenings and health services for vulnerable patients or population groups with chronic conditions who tend to underuse health services.
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Affiliation(s)
- Hannah Budde
- London School of Economics and Political Science, Houghton St, London, WC2A 2AE, UK.
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK
| | - Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany
| | - Laura Pfirter
- Maecenata Institut für Philanthropie und Zivilgesellschaft in Berlin, Rungestr. 17, D-10179, Berlin, Germany
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, Straße des 17. Juni 135, 10623, Berlin, Germany.
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Winkelmann J, Webb E, Williams GA, Hernández-Quevedo C, Maier CB, Panteli D. European countries' responses in ensuring sufficient physical infrastructure and workforce capacity during the first COVID-19 wave. Health Policy 2021; 126:362-372. [PMID: 34311982 PMCID: PMC9187509 DOI: 10.1016/j.healthpol.2021.06.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 06/01/2021] [Accepted: 06/30/2021] [Indexed: 12/23/2022]
Abstract
The COVID-19 pandemic has placed unprecedented pressure on health systems’ capacities. These capacities include physical infrastructure, such as bed capacities and medical equipment, and healthcare professionals. Based on information extracted from the COVID-19 Health System Reform Monitor, this paper analyses the strategies that 45 countries in Europe have taken to secure sufficient health care infrastructure and workforce capacities to tackle the crisis, focusing on the hospital sector. While pre-crisis capacities differed across countries, some strategies to boost surge capacity were very similar. All countries designated COVID-19 units and expanded hospital and ICU capacities. Additional staff were mobilised and the existing health workforce was redeployed to respond to the surge in demand for care. While procurement of personal protective equipment at the international and national levels proved difficult at the beginning due to global shortages, countries found innovative solutions to increase internal production and enacted temporary measures to mitigate shortages. The pandemic has shown that coordination mechanisms informed by real-time monitoring of available health care resources are a prerequisite for adaptive surge capacity in public health crises, and that closer cooperation between countries is essential to build resilient responses to COVID-19.
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Affiliation(s)
- Juliane Winkelmann
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623 Berlin, Germany.
| | - Erin Webb
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623 Berlin, Germany
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Cowdray House, Houghton Street, London WC2A 2AE, United Kingdom
| | - Cristina Hernández-Quevedo
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Cowdray House, Houghton Street, London WC2A 2AE, United Kingdom
| | - Claudia B Maier
- Department of Healthcare Management, Technische Universität Berlin, H 80, Straße des 17. Juni 135, 10623 Berlin, Germany; Center for Health Outcomes and Policy Research, University of Pennsylvania, School of Nursing, Claire Fagin Hall, 418 Curie Blvd, Philadelphia, PA 19104, United States
| | - Dimitra Panteli
- European Observatory on Health Systems and Policies, Eurostation, Place Victor Horta/Victor Hortaplein, 40/30, 1060 Brussels, Belgium
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Unruh L, Allin S, Marchildon G, Burke S, Barry S, Siersbaek R, Thomas S, Rajan S, Koval A, Alexander M, Merkur S, Webb E, Williams GA. A comparison of 2020 health policy responses to the COVID-19 pandemic in Canada, Ireland, the United Kingdom and the United States of America. Health Policy 2021; 126:427-437. [PMID: 34497031 PMCID: PMC9187506 DOI: 10.1016/j.healthpol.2021.06.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 06/08/2021] [Accepted: 06/24/2021] [Indexed: 01/04/2023]
Abstract
This paper compares health policy responses to COVID-19 in Canada, Ireland, the United Kingdom and United States of America (US) from January to November 2020, with the aim of facilitating cross-country learning. Evidence is taken from the COVID-19 Health System Response Monitor, a joint initiative of the European Observatory on Health Systems and Policies, the WHO Regional Office for Europe, and the European Commission, which has documented country responses to COVID-19 using a structured template completed by country experts. We show all countries faced common challenges during the pandemic, including difficulties in scaling-up testing capacity, implementing timely and appropriate containment measures amid much uncertainty and overcoming shortages of health and social care workers, personal protective equipment and other medical technologies. Country responses to address these issues were similar in many ways, but dissimilar in others, reflecting differences in health system organization and financing, political leadership and governance structures. In the US, lack of universal health coverage have created barriers to accessing care, while political pushback against scientific leadership has likely undermined the crisis response. Our findings highlight the importance of consistent messaging and alignment between health experts and political leadership to increase the level of compliance with public health measures, alongside the need to invest in health infrastructure and training and retaining an adequate domestic health workforce. Building on innovations in care delivery seen during the pandemic, including increased use of digital technology, can also help inform development of more resilient health systems longer-term.
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Affiliation(s)
- Lynn Unruh
- Department of Health Management and Informatics, University of Central Florida, 12494 University Blvd, Orlando, FL, USA.
| | - Sara Allin
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.
| | - Greg Marchildon
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, 155 College Street, Suite 425, Toronto, ON M5T 3M6, Canada.
| | - Sara Burke
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland.
| | - Sarah Barry
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland.
| | - Rikke Siersbaek
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland.
| | - Steve Thomas
- Centre for Health Policy and Management, School of Medicine, Trinity College Dublin, The University of Dublin, College Green, Dublin 2, Ireland.
| | - Selina Rajan
- Department of Health Services Research and Policy, The London School of Hygiene and Tropical Medicine, London, WC1H 9SH, UK.
| | - Andriy Koval
- Department of Health Management and Informatics, University of Central Florida, 12494 University Blvd, Orlando, FL, USA.
| | - Mathew Alexander
- Virginia Commonwealth University, School of Medicine, Richmond, VA 23284, USA.
| | - Sherry Merkur
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
| | - Erin Webb
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany.
| | - Gemma A Williams
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, UK.
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Williams GA, Jacob G, Rakovac I, Scotter C, Wismar M. Health professional mobility in the WHO European Region and the WHO Global Code of Practice: data from the joint OECD/EUROSTAT/WHO-Europe questionnaire. Eur J Public Health 2021; 30:iv5-iv11. [PMID: 32894282 PMCID: PMC7526770 DOI: 10.1093/eurpub/ckaa124] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
WHO Member States adopted the Global Code of Practice on the International Recruitment of Health Personnel 10 years ago. This study assesses adherence with the Code’s principles and its continuing relevance in the WHO Europe region with regards to international recruitment of health workers. Data from the joint OECD/EUROSTAT/WHO-Europe questionnaire from 2010 to 2018 are analyzed to determine trends in intra- and inter-regional mobility of foreign-trained doctors and nurses working in case study destination countries in Europe. In 2018, foreign-trained doctors and nurses comprised over a quarter of the physician workforce and 5% of the nursing workforce in five of eight and four of five case study countries, respectively. Since 2010, the proportion of foreign-trained nurses and doctors has risen faster than domestically trained professionals, with increased mobility driven by rising East-West and South-North intra-European migration, especially within the European Union. The number of nurses trained in developing countries but practising in case study countries declined by 26%. Although the number of doctors increased by 27%, this was driven by arrivals from countries experiencing conflict and volatility, suggesting countries generally are increasingly adhering to the Code’s principles on ethical recruitment. To support ethical recruitment practices and sustainable workforce development in the region, data collection and monitoring on health worker mobility should be improved.
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Affiliation(s)
| | | | - Ivo Rakovac
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Cris Scotter
- WHO Regional Office for Europe, Copenhagen, Denmark.,Department of Health and Social Care, London, UK
| | - Matthias Wismar
- European Observatory on Health Systems and Policies, Brussels, Belgium
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Oso AO, Lala OA, Oke EO, Williams GA, Taiwo AG, Ogunsola ZO. Effects of dietary supplementation with vitamin E, selenium yeast or both on egg incubation response, embryonic development, keet quality, and posthatch growth of helmeted guinea fowl breeders. Trop Anim Health Prod 2020; 52:2667-2675. [PMID: 32474755 DOI: 10.1007/s11250-020-02294-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 05/13/2020] [Indexed: 11/30/2022]
Abstract
This study investigated the effects of dietary supplementation with vitamin E (vit. E), selenium yeast (Se yeast), or both on egg incubation response, embryonic development, keet quality, and posthatch growth of helmeted guinea fowls. Two hundred and forty 24-week old helmeted guinea fowl hens (average weight 1.75 + 0.22 kg) and cocks (average weight 2.15 + 0.20 kg) were assigned into 24 pens; each pen housed 10 hens and 2 cocks. There were four dietary treatments consisting of a basal diet (control), basal diet supplemented with vit. E (30 IU/kg), Se yeast (0.3 mg/kg Se), or both. Six pens were assigned to each treatment. Egg incubation response were estimated using 504 settable eggs sampled from each treatment collected during 15 to 17 weeks in lay. A total of 72 fertile eggs sampled from each treatment were used for the estimation of embryonic development. Quality of day-old keets hatched was scored based on physical conditions, while posthatch growth was measured for 21 days. Guinea fowl breeders fed diet supplemented with both vit. E and Se yeast produced the highest (P < 0.05) number of fertile eggs, percentage fertility, number of hatchlings, hatchability of total eggs, and hatchability of fertile eggs. Supplementation with vit. E + Se yeast resulted in the heaviest (P < 0.05) embryo weight, relative embryo weight, least (P < 0.05) yolk sac weight, and relative yolk sac weight on 25 days of incubation. Hatchlings from breeders fed diet supplemented with Se yeast and vit. E + Se yeast showed normal swallowed yolk. Supplementation of maternal diet with vit. E, Se yeast, and vit. E + Se yeast resulted in improved (P < 0.05) feed conversion ratio of subsequent hatchlings during 1 to 7-day posthatch growth. It can be concluded that dietary supplementation of vit. E + Se yeast in guinea fowl breeders resulted in improved egg fertility, hatchability, heavier embryo weights, hatchlings of good quality, and improved posthatch growth during the first 7 days.
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Affiliation(s)
- A O Oso
- Department of Animal Nutrition, College of Animal Science and Livestock Production, Federal University of Agriculture, Abeokuta, PMB 2240, Nigeria.
| | - O A Lala
- Institute of Food Security, Environmental Resources and Agricultural Research, Federal University of Agriculture, Abeokuta, PMB 2240, Nigeria
| | - E O Oke
- Department of Animal Physiology, College of Animal Science and Livestock Production, Federal University of Agriculture, Abeokuta, PMB 2240, Nigeria
| | - G A Williams
- Department of Animal Nutrition, College of Animal Science and Livestock Production, Federal University of Agriculture, Abeokuta, PMB 2240, Nigeria
| | - A G Taiwo
- Department of Animal Nutrition, College of Animal Science and Livestock Production, Federal University of Agriculture, Abeokuta, PMB 2240, Nigeria
| | - Z O Ogunsola
- Department of Animal Nutrition, College of Animal Science and Livestock Production, Federal University of Agriculture, Abeokuta, PMB 2240, Nigeria
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Crickenberger S, Hui TY, Landry Yuan F, Bonebrake TC, Williams GA. Preferred temperature of intertidal ectotherms: Broad patterns and methodological approaches. J Therm Biol 2019; 87:102468. [PMID: 32001017 DOI: 10.1016/j.jtherbio.2019.102468] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 10/29/2019] [Accepted: 11/23/2019] [Indexed: 12/30/2022]
Abstract
Preferred temperature (Tpref) has been measured in over 100 species of aquatic and 300 species of terrestrial ectotherms as a metric for assessing behavioural thermoregulation in variable environments and, as such, has been linked to ecological processes ranging from individual behaviour to population and community dynamics. Due to the asymmetric shape of performance curves, Tpref is typically lower than the optimal temperature (Topt, where physiological performance is at its peak), and the degree of this mismatch increases with variability in Tb. Intertidal ectotherms experience huge variability in Tb on a daily basis and therefore provide a good system to test whether the relationship between Tpref and variation in Tb holds in more extreme environments. A review of the literature, however, only revealed comparisons between Tpref and Topt for five intertidal species and measurements of Tpref for 23 species. An analysis of this limited literature for intertidal ectotherms showed a positive relationship between acclimation temperature and Tpref. There was, however, great variation in the methodologies employed to make these assessments. Factors contributing to behavioural thermoregulation in intertidal ectotherms including small body size; low mobility; interactions among individuals; endogenous clocks; metabolic effects; thermal sensitivity; sampling of the thermal environment and recent acclimation history were considered to varying degrees when measuring Tpref, confounding comparisons between species. The methodologies used to measure Tpref in intertidal ectotherms were reviewed in light of each of these factors, and methodologies proposed to standardize approaches. Given the theoretical predictions about the relationships between Tpref and variability in Tb, the spatial and temporal thermal variability experienced by intertidal ectotherms provides numerous opportunities to test these expectations if assessed in a standardized manner, and can potentially provide insights into the value of behavioural thermoregulation in the more thermally variable environments predicted to occur in the near future.
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Affiliation(s)
- S Crickenberger
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China.
| | - T Y Hui
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - F Landry Yuan
- School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - T C Bonebrake
- School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China
| | - G A Williams
- The Swire Institute of Marine Science and School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, China
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Williams GA, Parmar D, Dkhimi F, Asante F, Arhinful D, Mladovsky P. Equitable access to health insurance for socially excluded children? The case of the National Health Insurance Scheme (NHIS) in Ghana. Soc Sci Med 2017; 186:10-19. [PMID: 28575734 DOI: 10.1016/j.socscimed.2017.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Revised: 03/01/2017] [Accepted: 05/06/2017] [Indexed: 10/19/2022]
Abstract
To help reduce child mortality and reach universal health coverage, Ghana extended free membership of the National Health Insurance Scheme (NHIS) to children (under-18s) in 2008. However, despite the introduction of premium waivers, a substantial proportion of children remain uninsured. Thus far, few studies have explored why enrolment of children in NHIS may remain low, despite the absence of significant financial barriers to membership. In this paper we therefore look beyond economic explanations of access to health insurance to explore additional wider determinants of enrolment in the NHIS. In particular, we investigate whether social exclusion, as measured through a sociocultural, political and economic lens, can explain poor enrolment rates of children. Data were collected from a cross-sectional survey of 4050 representative households conducted in Ghana in 2012. Household indices were created to measure sociocultural, political and economic exclusion, and logistic regressions were conducted to study determinants of enrolment at the individual and household levels. Our results indicate that socioculturally, economically and politically excluded children are less likely to enrol in the NHIS. Furthermore, households excluded in all dimensions were more likely to be non-enrolled or partially-enrolled (i.e. not all children enrolled within the household) than fully-enrolled. These results suggest that equity in access for socially excluded children has not yet been achieved. Efforts should be taken to improve coverage by removing the remaining small, annually renewable registration fee, implementing and publicising the new clause that de-links premium waivers from parental membership, establishing additional scheme administrative offices in remote areas, holding regular registration sessions in schools and conducting outreach sessions and providing registration support to female guardians of children. Ensuring equitable access to NHIS will contribute substantially to improving child health and reducing child mortality in Ghana.
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Affiliation(s)
- Gemma A Williams
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK.
| | - Divya Parmar
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK; School of Health Sciences, City University London, Northampton Square, London, EC1V 0HB, UK
| | - Fahdi Dkhimi
- Institute of Tropical Medicine, Nationalestraat 155, 2000 Antwerp, Belgium
| | - Felix Asante
- Institute of Statistical, Social and Economic Research, University of Ghana, P.O BOX LG 74, Legon, Ghana
| | - Daniel Arhinful
- Noguchi Memorial Institute for Medical Research, University of Ghana, P.O. BOX LG 581, Legon, Ghana
| | - Philipa Mladovsky
- LSE Health, London School of Economics and Political Science, Houghton Street, London WC2A 2AE, UK
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16
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Williams GA, O'Brien RS, Grzechnik M, Wise KN. ESTIMATES OF RADIATION DOSES TO THE SKIN FOR PEOPLE CAMPED AT WALLATINNA DURING THE UK TOTEM 1 ATOMIC WEAPONS TEST. Radiat Prot Dosimetry 2017; 174:322-336. [PMID: 27881792 DOI: 10.1093/rpd/ncw192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 06/22/2016] [Indexed: 06/06/2023]
Abstract
A group of Aboriginal people was camped at Wallatinna in South Australia, ~170 km downwind from Emu Field, where an atomic test (the Totem 1 test) was carried out at 07.00 on 15 October 1953 local time (21.30 on 14 October 1953 GMT (Greenwich Mean Time)). They left the camp ~24 hours later. These people stated that a phenomenon that has become known as a 'black mist' rolled through their camp site ~5 hours after detonation and that some of them subsequently became sick, displaying skin reddening and nausea. They feared that the sickness was a result of exposure to high levels of radiation. The purpose of this paper is to determine if these people could have received ionising radiation doses high enough to cause the symptoms displayed. The methodology used for the dose estimates is described in the paper. The exposure modes considered were external exposure due to the passage of a contaminated plume over the camp site, inhalation of material from this plume, external exposure from material deposited on the ground as the plume passed, and consumption of contaminated food and water. The contaminants considered in the airborne cloud and the ground plume were fission products and unburnt plutonium from the nuclear detonation, and neutron activation products caused by vaporisation of the tower used to position the weapon. The source was approximated by a line source. An upper estimate of the effective doses received is ~4 mSv, which is well below the level at which acute radiation effects are observed. This estimate is consistent with earlier assessments, which did not consider inhalation of the contribution from neutron activation products.
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Affiliation(s)
- G A Williams
- ARPANSA, 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - R S O'Brien
- ARPANSA, 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - M Grzechnik
- ARPANSA, 619 Lower Plenty Road, Yallambie, VIC 3085, Australia
| | - K N Wise
- 11 Kinnear Court, Montmorency, VIC 3094, Australia
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17
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Williams GA, Bacci S, Shadwick R, Tillmann T, Rechel B, Noori T, Suk JE, Odone A, Ingleby JD, Mladovsky P, Mckee M. Measles among migrants in the European Union and the European Economic Area. Scand J Public Health 2015; 44:6-13. [PMID: 26563254 PMCID: PMC4741262 DOI: 10.1177/1403494815610182] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/10/2015] [Indexed: 11/16/2022]
Abstract
Aims: Progress towards meeting the goal of measles elimination in the EU and the European Economic Area (EEA) by 2015 is being obstructed, as some children are either not immunized on time or never immunized. One group thought to be at increased risk of measles is migrants; however, the extent to which this is the case is poorly understood, due to a lack of data. This paper addresses this evidence gap by providing an overview of the burden of measles in migrant populations in the EU/EEA. Methods: Data were collected through a comprehensive literature review, a country survey of EU/EEA member states and information from measles experts gathered at an infectious disease workshop. Results: Our results showed incomplete data on measles in migrant populations, as national surveillance systems do not systematically record migration-specific information; however, evidence from the literature review and country survey suggested that some measles outbreaks in the EU/EEA were due to sub-optimal vaccination coverage in migrant populations. Conclusions: We conclude that it is essential that routine surveillance of measles cases and measles, mumps and rubella (MMR) vaccination coverage become strengthened, to capture migrant-specific data. These data can help to inform the provision of preventive services, which may need to reach out to vulnerable migrant populations that currently face barriers in accessing routine immunization and health services.
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Affiliation(s)
- Gemma A Williams
- LSE Health, London School of Economics and Political Science (LSE), London, UK
| | - Sabrina Bacci
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Rebecca Shadwick
- LSE Health, London School of Economics and Political Science (LSE), London, UK
| | - Taavi Tillmann
- ECOHOST, London School of Hygiene and Tropical Medicine, London, UK
| | - Bernd Rechel
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
| | - Teymur Noori
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Anna Odone
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK Department of Global Health and Social Medicine, Harvard School of Public Health, Harvard University, Boston, MA, USA
| | | | - Philipa Mladovsky
- LSE Health, London School of Economics and Political Science (LSE), London, UK
| | - Martin Mckee
- European Observatory on Health Systems and Policies, London School of Hygiene and Tropical Medicine, London, UK
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Williams GA, Ott TL, Michal JJ, Gaskins CT, Wright RW, Daniels TF, Jiang Z. BRIEF NOTES: Development of a model for mapping cryptorchidism in sheep and initial evidence for association of INSL3 with the defect. Anim Genet 2007; 38:189-91. [PMID: 17355391 DOI: 10.1111/j.1365-2052.2007.01585.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- G A Williams
- Department of Animal Sciences, Washington State University, Pullman, WA 99164-6351, USA
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Abstract
Macular hole size is a predictor for anatomical closure. Holes >400 μm in aperture size on an OCT scan are more likely to close when ILM is peeled
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Hermel M, Mahgoub M, Youssef T, Azrak MI, Raza H, Alldredge C, Trese M, Williams GA, Hartzer M. Safety profile of the intravitreal streptokinase-plasmin complex as an adjunct to vitrectomy in the rabbit. Graefes Arch Clin Exp Ophthalmol 2005; 244:996-1002. [PMID: 16365737 DOI: 10.1007/s00417-005-0159-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2005] [Revised: 08/30/2005] [Accepted: 09/19/2005] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The generation of an atraumatic posterior vitreous detachment (PVD), a common goal in vitreoretinal surgery, is a challenge, particularly in children and young trauma patients. Plasmin has been proposed as an adjunct to vitrectomy to enzymatically generate a PVD. Low doses of streptokinase-activated plasmin were tested in human pilot studies. This dose-escalation study assesses the safety range of intravitreal human streptokinase-plasmin in rabbits. METHODS Plasminogen was isolated from human plasma by affinity chromatography, followed by activation with streptokinase (1:1), to generate the streptokinase-plasmin complex. Enzyme doses from 0.1-7 activity units (AU, in 0.1 ml) were injected into the mid-vitreous of 35 eyes; six control eyes were injected with balanced salt solution (BSS, 0.1 ml). Thirty minutes after injection, a two-port vitrectomy was performed. Fundus and slit lamp examinations were performed on days 1 and 7. On days 2 and 7, bright flash electroretinography was performed and compared with preoperative recordings. Some animals receiving higher doses of streptokinase-plasmin (1-7 AU) were followed clinically and with electroretinography for up to 9 months. RESULTS A mild-to-moderate inflammatory response was seen in both control and plasmin-treated eyes on day 1, but had disappeared completely by day 7 in most eyes. In the 7 AU group, inflammation was stronger and more protracted. Two of three eyes from this group developed wrinkling of the medullary rays; one of them showed discoloration and traction at the medullary rays in the late follow-up. Electroretinograms (ERGs) of vitrectomized control eyes showed the following changes from preoperative values: 48 h, a-wave -11.10% [no significant (n.s.)], b-wave -14.62% (P=0.046); 7 days, a-wave +9.18% (n.s.), b wave +11.69% (n.s.). For the enzyme-treated eyes: 48 h: a-wave -20.43% (P<0.001), b-wave -9.57% (p<0.001); 7 days: a wave -14.21% (P<0.001), b-wave +2.48% (P<0.001). There was no evidence of dose-dependent ERG changes in enzyme-treated eyes at doses up to 5 AU. Groups of up to 3 AU were investigated by light and transmission electron microscopy, without evidence of toxicity. CONCLUSION Streptokinase-plasmin doses up to 3 AU were found to be safe when injected into rabbit eyes followed by vitrectomy.
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Affiliation(s)
- M Hermel
- Department of Ophthalmology, RWTH Aachen University, Pauwelsstrasse 30, 52057, Aachen, Germany.
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Pal B, Mohamed MD, Keen TJ, Williams GA, Bradbury JA, Sheridan E, Inglehearn CF. A new phenotype of recessively inherited foveal hypoplasia and anterior segment dysgenesis maps to a locus on chromosome 16q23.2-24.2. J Med Genet 2005; 41:772-7. [PMID: 15466012 PMCID: PMC1735603 DOI: 10.1136/jmg.2004.020040] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Farah ME, Cardillo JA, Luzardo AC, Calucci D, Williams GA, Costa RA. Indocyanine green mediated photothrombosis for the management of predominantly classic choroidal neovascularisation caused by age related macular degeneration. Br J Ophthalmol 2004; 88:1055-9. [PMID: 15258024 PMCID: PMC1772261 DOI: 10.1136/bjo.2003.035808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2003] [Indexed: 11/03/2022]
Abstract
AIMS To study the effectiveness of indocyanine green mediated photothrombosis in the management of predominantly classic subfoveal choroidal neovascularisation associated with age related macular degeneration. METHODS Prospective, non-comparative, interventional case series of nine patients with predominantly classic subfoveal choroidal neovascularisation secondary to age related macular degeneration who declined photocoagulation or verteporfin photodynamic therapy. Patients were submitted to one or more treatments with an intravenous injection of a small volume of high concentration indocyanine green solution followed by low irradiance, large spot 810 nm continuous laser application via a transpupillary approach. Main outcome measures were change in best corrected visual acuity and macular exudative manifestations. RESULTS After 12 months of follow up, the final best corrected visual acuity was the same (plus or minus two ETDRS lines) in five eyes (55%), improved more than two ETDRS lines in three eyes (33%), and worsened by more than two lines in the remaining eye. The improved vision was probably related to partial or complete restoration of the macular architecture as a result of fluid resolution, whereas the worsened vision was primarily the result of treatment failure in achieving substantial choroidal neovascular occlusion. There were no complications related to the procedure. CONCLUSION Indocyanine green mediated photothrombosis may be an effective alternative treatment for predominantly classic subfoveal choroidal neovascularisation caused by age related macular degeneration.
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Affiliation(s)
- M E Farah
- Department of Ophthalmology, Instituto da Visão-IPEPO, Federal University of São Paulo, School of Medicine, Brazil.
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Chelazzi G, De Pirro M, Williams GA. Different cardiac response to copper in limpets from metal polluted and clean shores of Hong Kong. Mar Environ Res 2004; 58:83-93. [PMID: 15046947 DOI: 10.1016/j.marenvres.2004.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2003] [Accepted: 01/03/2004] [Indexed: 05/24/2023]
Abstract
The gastropod limpet, Cellana grata, is common on moderately exposed to exposed Hong Kong rocky shores. On the basis of the existing literature on trace metal contamination in Hong Kong, four sites were identified, representative of highly polluted (Aberdeen and Lei Yue Mun) and clean (Cape d'Aguilar and Clear Water Bay) conditions. Limpets from the two polluted sites showed similar, but significantly higher body concentrations of copper than limpets from the two clean sites, which were also similar. Non-invasive measurements of cardiac activity of limpets from the four sites showed between site differences in baseline heart rates under standard seawater, irrespective of pollution level. When acutely exposed to water borne copper (2 h, 0.5+/-0.06 SD ppm), however, limpets from clean sites showed a significantly higher increase in inter-beating time (bradycardia) than those from polluted sites. These results highlight the potential use of cardiac activity to assess the exposure of natural populations of limpets to trace metal pollution.
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Affiliation(s)
- G Chelazzi
- Dipartimento di Biologia Animale e Genetica, Università degli Studi di Firenze, Via Romana 17, 50125 Firenze, Italy
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Jacobs GH, Calderone JB, Fenwick JA, Krogh K, Williams GA. Visual adaptations in a diurnal rodent, Octodon degus. J Comp Physiol A Neuroethol Sens Neural Behav Physiol 2003; 189:347-61. [PMID: 12679876 DOI: 10.1007/s00359-003-0408-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2002] [Revised: 02/18/2003] [Accepted: 03/05/2003] [Indexed: 10/25/2022]
Abstract
The degu (Octodon degus) is a diurnal rodent, native to Chile. Basic features of vision and visual organization in this species were examined in a series of anatomical, electrophysiological and behavioral experiments. The lens of the degu eye selectively absorbs short-wavelength light and shows a progressive increase in optical density as a function of age. Electroretinograms recorded using a flicker-photometric procedure reveal three spectral mechanisms: a rod with peak sensitivity of about 500 nm and two types of cone having respective spectral peaks of about 362 nm and 507 nm. Opsin antibody labeling was used to determine the retinal distributions of the three receptor types. A total of about one-third of the approximately 9 million photoreceptors of the degu retina are cones with the two types (507 nm/362 nm) represented in a ratio of about 13:1. The contributions to vision of all three receptor types were examined in a series of behavioral experiments. A consistent feature of both the electrophysiological and behavioral results is that relatively high levels of light adaptation are required to effect the full transition from rod-based to cone-based vision. In behavioral tests degus were shown to be able to make color discriminations between ultraviolet and visible lights.
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Affiliation(s)
- G H Jacobs
- Neuroscience Research Institute, University of California, Santa Barbara, CA 93106, USA.
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Abstract
Finding optimal three-dimensional molecular configurations based on a limited amount of experimental and/or theoretical data requires efficient nonlinear optimization algorithms. Optimization methods must be able to find atomic configurations that are close to the absolute, or global, minimum error and also satisfy known physical constraints such as minimum separation distances between atoms (based on van der Waals interactions). The most difficult obstacles in these types of problems are that 1) using a limited amount of input data leads to many possible local optima and 2) introducing physical constraints, such as minimum separation distances, helps to limit the search space but often makes convergence to a global minimum more difficult. We introduce a constrained global optimization algorithm that is robust and efficient in yielding near-optimal three-dimensional configurations that are guaranteed to satisfy known separation constraints. The algorithm uses an atom-based approach that reduces the dimensionality and allows for tractable enforcement of constraints while maintaining good global convergence properties. We evaluate the new optimization algorithm using synthetic data from the yeast phenylalanine tRNA and several proteins, all with known crystal structure taken from the Protein Data Bank. We compare the results to commonly applied optimization methods, such as distance geometry, simulated annealing, continuation, and smoothing. We show that compared to other optimization approaches, our algorithm is able combine sparse input data with physical constraints in an efficient manner to yield structures with lower root mean squared deviation.
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Affiliation(s)
- G A Williams
- Stanford Medical Informatics, Stanford University, Stanford, CA, 94305-5479, USA.
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Sarrafizadeh R, Hassan TS, Ruby AJ, Williams GA, Garretson BR, Capone A, Trese MT, Margherio RR. Incidence of retinal detachment and visual outcome in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. Ophthalmology 2001; 108:2273-8. [PMID: 11733270 DOI: 10.1016/s0161-6420(01)00822-3] [Citation(s) in RCA: 81] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
PURPOSE To determine visual outcomes and the incidence of retinal detachment in eyes presenting with posterior vitreous separation and dense fundus-obscuring vitreous hemorrhage. DESIGN Retrospective consecutive noncomparative interventional case series. PARTICIPANTS Thirty-six eyes (15 right eyes and 21 left eyes) of 34 patients (18 female and 16 male) ranging in age from 42 to 94 years. Mean follow-up was 14 months. METHODS A comparison of the best-corrected initial visual acuities versus final visual acuities after spontaneous resolution of vitreous hemorrhage or surgical intervention. The number of eyes that were found to have retinal tears or that had a rhegmatogenous retinal detachment develop was documented. Logarithm of the minimum angle of resolution-converted visual acuities was used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by Student's t test. MAIN OUTCOME MEASURES Final mean visual acuities, number of eyes with at least one retinal tear, location of retinal tears, number of eyes that had retinal detachment develop, and the number of eyes repaired with scleral buckling surgery and/or pars plana vitrectomy. RESULTS Twenty-four of 36 eyes (67%) were found to have at least one retinal break (range, 0-4 breaks), with 88% of breaks located in the superior retina. Eleven eyes (31%) had more than one retinal break. Fourteen of 36 eyes (39%) had a rhegmatogenous retinal detachment develop that was repaired with pars plana vitrectomy and scleral buckling. An additional 14 eyes (39%) underwent vitrectomy for nonclearing vitreous hemorrhage. The incidence of retinal detachment in eyes with a history of retinal detachment in the contralateral eye was 75% (P = 0.04). Seven of 14 eyes (50%) with retinal detachment had coexisting proliferative vitreoretinopathy. Most retinal breaks and detachments occurred in emmetropic or myopic eyes. For all 36 eyes the mean preoperative visual acuity was 20/1233, and the mean final visual acuity was 20/62 (P < 0.0001). Eyes that had a macula-off retinal detachment develop had worse final visual outcomes (20/264; P = 0.01), as did eyes that had proliferative vitreoretinopathy develop (20/129; P = 0.04). CONCLUSIONS Acute, spontaneous, nontraumatic posterior vitreous separation with dense fundus-obscuring vitreous hemorrhage is associated with a high incidence of retinal tears and detachment. Close follow-up with clinical examination and ultrasonography is necessary, because many of these eyes may eventually require surgical intervention. Aggressive management with early vitrectomy should be considered when there is a history of retinal detachment in the contralateral eye.
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Affiliation(s)
- R Sarrafizadeh
- Associated Retinal Consultants, PC, William Beaumont Hospital, 3535 W 13 Mile Road, Suite 632, Royal Oak, MI 48073, USA
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Abstract
PURPOSE To describe acquired ocular toxoplasmosis in deer hunters. METHODS AND RESULTS The authors describe five young men presenting with flu-like symptoms followed by visual loss due to a unilateral, focal necrotizing retinitis. All five men gave a history of ingesting undercooked or uncooked venison. All five had elevated toxoplasma serology, and all five improved clinically with an antitoxoplasma regimen. CONCLUSION In previously healthy young men, flu-like symptoms associated with visual loss and retinitis should prompt questioning about hunting and raw game meat ingestion, especially when toxoplasmosis is suspected.
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Affiliation(s)
- R D Ross
- Retina Vitreous Center, Grand Blanc, Michigan, USA
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Abstract
PURPOSE This is a pilot study to assess the use of autologous plasmin enzyme (APE) as an adjunct to vitreous surgery in eyes with advanced diabetic retinopathy. DESIGN Prospective noncomparative interventional case series. PARTICIPANTS Seven patients with advanced diabetic retinopathy selected at random from our practice population. METHODS Seven eyes were treated with APE as an adjunct to standard vitreous surgery. Six eyes had macular tractional retinal detachments, and one eye had refractory macular edema. Three fellow eyes had standard vitreous surgery performed for macular tractional retinal detachments without APE. All 10 eyes had macular edema and background diabetic retinopathy. MAIN OUTCOME MEASURES The main outcome measures included induction of a posterior vitreous detachment, retinal reattachment, improvement in visual acuity, and resolution of macular edema. RESULTS All seven APE-treated eyes achieved spontaneous or easy removal of the posterior hyaloid including one eye that had vitreoschisis over areas of detached retina. All eyes treated with APE had resolution of intraretinal edema. Retinas of all eyes treated with APE were reattached. The three fellow eyes were treated by vitreous surgery without APE. Two of the three fellow eyes had reattached retinas, but none had resolution of intraretinal edema without further focal photocoagulation treatment. Mean visual acuity improvement was 0.7 logarithm of the minimum angle of resolution (LogMAR) units in APE-treated eyes and 0.1 LogMAR units in eyes without APE. The average follow-up period was 14 months. CONCLUSIONS This pilot study suggests that APE may be beneficial in the surgical management of diabetic retinopathy.
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Affiliation(s)
- J G Williams
- William Beaumont Hospital, Royal Oak, Michigan, USA
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Abstract
PURPOSE To describe the results of retinal tears and rhegmatogenous retinal detachments (RD) in adults with retinopathy of prematurity (ROP). DESIGN Noncomparitive interventional case series. METHODS Retrospective cohort of 216 eyes of 108 patients, 15 years or older, followed for up to 23 years (median, 6.2 years). RESULTS One eye was initially seen with an RD, and during follow-up 30 eyes had an RD develop. An additional surgical procedure was required in 7 of the 31 eyes (23%) with an RD. Four eyes were initially seen with retinal tears, and during follow-up 19 eyes had a retinal tear develop. Seven of the 23 eyes (30%) with a retinal tear had initial repair fail. Eyes with minimal cicatricial changes from ROP were still at high risk for tears and detachments developing. Eighty percent of eyes with retinal tears and 60% of eyes with an RD that started with vision >20/60 maintained that level of vision at the final examination. CONCLUSION In patients with a history of premature birth, features of fundus examinations do not correlate with the occurrence of a retinal tear or RD. Repair of a tear or detachment in such a patient is more likely to require multiple procedures but can still be associated with good visual results. Physicians should consider widespread relief of vitreoretinal traction for a tear or detachment in any patient with a history of premature birth.
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Affiliation(s)
- R S Kaiser
- Associated Retinal Consultants, Royal Oak, Michigan 48073, USA
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Pollack AL, McDonald HR, Ai E, Green WR, Halpern LS, Jampol LM, Leahy JM, Johnson RN, Spencer WH, Stern WH, Weinberg DV, Werner JC, Williams GA. Sympathetic ophthalmia associated with pars plana vitrectomy without antecedent penetrating trauma. Retina 2001; 21:146-54. [PMID: 11321141 DOI: 10.1097/00006982-200104000-00008] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To evaluate, describe, and categorize the clinical presentation, clinical course, histopathology, and response to therapy in patients without a history of penetrating ocular trauma who developed sympathetic ophthalmia following pars plana vitrectomy. METHODS The records of patients without a history of trauma who underwent pars plana vitrectomy and developed sympathetic ophthalmia were retrospectively reviewed. Cases were analyzed with respect to clinical presentation, fluorescein angiographic findings, anatomic and visual outcomes, histopathology, and response to therapy. RESULTS Eight eyes were identified. The median age at presentation was 55 years, with a range of 14 to 62 years. The time from vitrectomy to diagnosis of sympathetic ophthalmia ranged from 2 months to greater than 2 years, with a median of 7 months. Six of eight patients (75%) presented with anterior chamber reaction. All eight patients presented with a vitreous inflammatory response. The optic nerve was inflamed clinically or angiographically in four of eight cases (50%). Small yellow-white sub-retinal pigment epithelial deposits were present in four of eight cases (50%). Two eyes had lesions characterized as multifocal choroiditis. One eye had larger yellow placoid-like lesions. One eye presented with vitritis but no retinal lesions. Subretinal choroidal neovascularization was noted in the inciting eye of one patient. Vision improved in the sympathizing eye with immunosuppressive therapy in five of eight cases (62.5%). CONCLUSIONS Sympathetic ophthalmia can be seen following pars plana vitrectomy in patients without penetrating injuries or a history of trauma. Indeed, it may be seen after successful vitrectomy for retinal detachment. Diverse clinical presentations are possible, and persistent or atypical uveitis following vitrectomy should alert the surgeon to the development of sympathetic ophthalmia.
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Affiliation(s)
- A L Pollack
- Retina Research Fund, St. Mary's Medical Center, San Francisco, CA, USA
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31
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Hiner AN, Hernández-Ruiz J, Williams GA, Arnao MB, García-Cánovas F, Acosta M. Catalase-like oxygen production by horseradish peroxidase must predominantly be an enzyme-catalyzed reaction. Arch Biochem Biophys 2001; 392:295-302. [PMID: 11488605 DOI: 10.1006/abbi.2001.2460] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
When hydrogen peroxide (H2O2) was provided as the only substrate for horseradish peroxidase C (HRP-C) the catalase-like emission of oxygen gas was observed. The reaction was favored at neutral compared to acidic pH. Addition of the superoxide radical scavengers tetranitromethane (TNM) or superoxide dismutase (SOD) increased activity. TNM's effect was concentration dependent but SOD's was not, indicating that only some of the superoxide generated was released into solution. Manganous ions (Mn2+) react with superoxide radicals to regenerate H2O2 but not oxygen; when added to the reaction medium oxygen production was reduced but not abolished. The effect was essentially concentration independent, suggesting that most oxygen was produced enzymatically and not by chemical disproportionation of superoxide. The catalase-like activities of some site-directed mutants of HRP-C suggest that active site residues histidine 42 and arginine 38 are influential in determining this activity. A clear correlation also existed between catalase activity and the enzymes' resistance to inactivation by H2O2. Computer simulation of a reaction scheme that included catalase-like activity agreed well with experimental data.
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Affiliation(s)
- A N Hiner
- Departamento de Biología Vegetal, Fisiología Vegetal, Universidad de Murcia, Espinardo, Murcia, E-30100, Spain
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Abstract
SUMMARY
Rats (Rattus norvegicus) have two classes of cone, one containing an ultraviolet (UV)-sensitive photopigment and the other housing a pigment maximally sensitive in the middle (M) wavelengths of the visible spectrum. The manner in which signals from these two cone types contribute to rat vision was investigated through recordings of a gross electrical potential (the electroretinogram, ERG) and behavioral discrimination tests. Spectral sensitivity functions obtained from both types of measurement indicate clear contributions from each of the cone classes, but there is a marked enhancement of the relative sensitivity to UV light in the behavioral index; for instance, under some photopic test conditions, rats are approximately equally sensitive to middle-wavelength and UV lights. In adaptation tests, thresholds for UV and M lights were found to be differentially elevated in the presence of chromatic adapting backgrounds, thus providing the possibility that signals from the two cones could be used by the rat visual system to support color discriminations. Evidence of dichromatic color vision in the rat was subsequently obtained from tests of wavelength discrimination.
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Affiliation(s)
- G H Jacobs
- Neuroscience Research Institute and Department of Psychology, University of California, Santa Barbara 93106, USA.
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Benson WE, Cruickshanks KC, Fong DS, Williams GA, Bloome MA, Frambach DA, Kreiger AE, Murphy RP. Surgical management of macular holes: a report by the American Academy of Ophthalmology. Ophthalmology 2001; 108:1328-35. [PMID: 11425696 DOI: 10.1016/s0161-6420(01)00731-x] [Citation(s) in RCA: 131] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE The document describes macular hole surgery and examines the available evidence to address questions about the efficacy of the procedure for different stages of macular hole, complications during and after surgery, and modifications to the technique. METHODS A literature search conducted for the years 1968 to 2000 retrieved over 400 citations that matched the search criteria. This information was reviewed by panel members and a methodologist, and it was evaluated for the quality of the evidence presented. RESULTS There are three multicenter, controlled, randomized trials that constitute Level I evidence and compare the value of surgery versus observation for macular hole. There are three multicenter, controlled, randomized trials studying the use of adjuvant therapy in macular hole repair. Postoperative vision of 20/40 or better has been reported in 22% to 49% of patients in randomized trials. The risks of surgical complications include retinal detachment (3%), endophthalmitis (<1%), cataract (>75%), and late reopening the hole (2% to 10%). CONCLUSIONS The evidence does not support surgery for patients with stage 1 holes. Level I evidence supports surgery for stage 2 holes to prevent progression to later stages of the disease and further visual loss. Level I evidence shows that surgery improves the vision in a majority of patients with stage 3 and stage 4 holes. There is no strong evidence that adjuvant therapy used at the time of surgery results in improved surgical outcomes. Patient inconvenience, patient preference, and quality of life issues have not been studied.
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Abstract
Given the high rate at which biological data are being collected and made public, it is essential that computational tools be developed that are capable of efficiently accessing and analyzing these data. High-performance distributed computing resources can play a key role in enabling large-scale analyses of biological databases. We use a distributed computing environment, Legion, to enable large-scale computations on the Protein Data Bank (PDB). In particular, we employ the Feature program to scan all protein structures in the PDB in search for unrecognized potential cation binding sites. We evaluate the efficiency of Legion's parallel execution capabilities and analyze the initial biological implications that result from having a site annotation scan of the entire PDB. We discuss four interesting proteins with unannotated, high-scoring candidate cation binding sites.
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Affiliation(s)
- A Waugh
- Stanford Medical Informatics, 251 Campus Drive, MSOB X-215, Stanford, CA 94305-5479, USA.
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35
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Baghdassarian O, Chu HC, Tabbert B, Williams GA. Spectrum of luminescence from laser-created bubbles in water. Phys Rev Lett 2001; 86:4934-4937. [PMID: 11384385 DOI: 10.1103/physrevlett.86.4934] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2001] [Indexed: 05/23/2023]
Abstract
The spectrum of the luminescence emitted at the collapse of single laser-induced bubbles in water is measured for different maximum bubble radii. Bubbles as large as 2 mm show a molecular OH(*) band at 310 nm in the spectrum, which otherwise can be fitted approximately with a blackbody curve at a temperature of 7800 K. This finding provides a connection between the light emission of single bubbles and multibubble sonoluminescence, since in the latter case the same molecular band is observed. Surface instabilities are observed in the larger bubbles, and may be connected with the OH(*) emission.
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Affiliation(s)
- O Baghdassarian
- Department of Physics and Astronomy, University of California, Los Angeles, CA 90095, USA
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Cohen MH, Hirschfeld S, Flamm Honig S, Ibrahim A, Johnson JR, O'Leary JJ, White RM, Williams GA, Pazdur R. Drug approval summaries: arsenic trioxide, tamoxifen citrate, anastrazole, paclitaxel, bexarotene. Oncologist 2001; 6:4-11. [PMID: 11161223 DOI: 10.1634/theoncologist.6-1-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This report summarizes information on drugs recently approved by the Food and Drug Administration, Office of Drug Evaluation I, Division of Oncology Drug Products. Five applications supporting new claims will be discussed: Trisenox (arsenic trioxide) for induction of remission and consolidation in patients with acute promyelocytic leukemia who are refractory to, or have relapsed from, retinoid and anthracycline chemotherapy, and whose disease is characterized by the presence of the t(15;17) translocation or PML/RAR-alpha gene expression; Nolvadex (tamoxifen citrate) in women with ductal carcinoma in situ, following breast surgery and radiation, to reduce the risk of invasive breast cancer; Arimidex (anastrazole) for first-line treatment of postmenopausal women with hormone receptor positive or hormone receptor unknown locally advanced or metastatic breast cancer; Taxol (paclitaxel), 175 mg/m(2) by 3 h infusion in combination with cisplatin for first-line treatment of advanced ovarian cancer; and Targretin gel (bexarotene) for the topical treatment of cutaneous lesions in patients with stage IA and IB cutaneous T-cell lymphoma who have not tolerated other therapies or who have refractory or persistent disease. Information provided includes rationale for drug development, study design, efficacy and safety results, and pertinent literature references.
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Affiliation(s)
- M H Cohen
- Division of Oncology Drug Products, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, Rockville, Maryland 20852, USA.
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Rich C, Bernstein DS, Gates S, Heaney RP, Johnston CC, Rosenberg CA, Schnaper HW, Tewksbury RB, Williams GA. Factors involved in an objective study of the efficacy of treatment of osteoporosis. Clin Orthop Relat Res 2001; 45:63-6. [PMID: 5937374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Chu HC, Williams GA. Quenched Kosterlitz-Thouless superfluid transitions. Phys Rev Lett 2001; 86:2585-2588. [PMID: 11289986 DOI: 10.1103/physrevlett.86.2585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2000] [Indexed: 05/23/2023]
Abstract
Rapidly quenched Kosterlitz-Thouless (KT) superfluid transitions are studied by solving the Fokker-Planck equation for the vortex-pair dynamics in conjunction with the KT recursion relations. Power-law decays of the vortex density at long times are found, and the results are in agreement with a scaling proposal made by Minnhagen and co-workers for the dynamical critical exponent. The superfluid density is strongly depressed after a quench, with the subsequent recovery being logarithmically slow for starting temperatures near T(KT). No evidence is found of vortices being "created" in a rapid quench; there is only decay of the existing thermal vortex pairs.
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Affiliation(s)
- H C Chu
- Department of Physics and Astronomy, University of California, Los Angeles, California 90095, USA
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Horn EP, McDonald HR, Johnson RN, Ai E, Williams GA, Lewis JM, Rubsamen PE, Sternberg P, Bhisitkul RB, Mieler WF. Soccer ball-related retinal injuries: a report of 13 cases. Retina 2001; 20:604-9. [PMID: 11131412 DOI: 10.1097/00006982-200011000-00003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the clinical characteristics and management of retinal injuries caused by soccer ball impact as well as the mechanism of injury, prognostic features, risk factors, and possible prevention strategies. METHODS Thirteen cases of soccer ball injuries from retina referral practices were retrospectively reviewed, with attention to the mechanism of associated ocular complications and the anatomic and visual outcomes. RESULTS Soccer ball injuries occurred in both male and female patients (9 male, 4 female) with ages ranging from 8 to 21 years (median 14 years). These patients were observed from 0 to 64 months (median follow-up, 8 months). Four patients had traumatic macular holes, two eyes had retinal detachment associated with retinal dialysis, two had retinal tears associated with hemorrhage, one had a choroidal rupture, and one had only vitreous hemorrhage and Berlin's edema. Although six eyes had some degree of traumatic retinal pigment epitheliopathy, it was the primary diagnosis in only three. Visual acuity at presentation ranged from 20/20 to count fingers, with 7/13 (54%) having 20/200 or worse vision. Seven eyes underwent surgical procedures; the remainder were observed. Final visions ranged from 20/20 to count fingers, with 3/13 (23%) having 20/200 or worse vision. Six eyes (46%) improved by two or more lines by the last follow-up. CONCLUSION Soccer ball-related ocular injuries disproportionately affect young players, are more frequent in females than previously reported, and have more severe visual consequences than previously recognized. Injury prevention strategies to minimize contact between the eye and the soccer ball may reduce the incidence and severity of eye injuries.
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Affiliation(s)
- E P Horn
- Department of Ophthalmology, California Pacific Medical Center, San Francisco, USA
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40
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Chow DR, Garretson BR, Kuczynski B, Williams GA, Margherio R, Cox MS, Trese MT, Hassan T, Ferrone P. External versus internal approach to the removal of metallic intraocular foreign bodies. Retina 2001; 20:364-9. [PMID: 10950413 DOI: 10.1097/00006982-200007000-00007] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review the management of metallic intraocular foreign bodies (IOFB) at a single institution and to compare the use of internal and external approaches for their removal. SUBJECTS AND METHODS A retrospective review was conducted on 70 eyes from 70 patients who underwent surgical removal of a metallic IOFB with either an internal (vitrectomy followed by forceps or internal magnet use) or external approach (large electromagnet) by seven vitreoretinal surgeons at a single institution between 1973 and 1996. Visual acuity and complications occurring with the two approaches were the main outcome measures studied. RESULTS Overall, patients showed significant improvement in visual acuity following surgical intervention (P < 0.001) despite widely varying surgical techniques. When the authors compared patients treated with an external versus an internal approach they found no statistically significant difference with regard to visual outcome and a trend toward a higher rate of postoperative endophthalmitis in the external approach group. CONCLUSION Surgical removal of metallic IOFB results in significant visual improvement. The external approach to the removal of magnetic metallic IOFB remains a viable treatment option in select cases.
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Affiliation(s)
- D R Chow
- Department of Ophthalmology, McGill University, Montreal, Quebec, Canada
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41
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Affiliation(s)
- R Sarrafizadeh
- Associated Retinal Consultants and William Beaumont Hospital, Royal Oak, Michigan 48073, USA
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Banach MJ, Hassan TS, Cox MS, Margherio RR, Williams GA, Garretson BR, Trese MT. Clinical course and surgical treatment of macular epiretinal membranes in young subjects. Ophthalmology 2001; 108:23-6. [PMID: 11150258 DOI: 10.1016/s0161-6420(00)00473-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To examine the surgical and nonsurgical visual outcomes of young subjects with idiopathic macular epiretinal membranes (ERMs). DESIGN Retrospective observational and noncomparative interventional case series. PARTICIPANTS Nineteen consecutive subjects (20 eyes) aged 40 years or less with an idiopathic macular ERM. METHODS Group 1: 10 consecutive eyes were initially seen with visual acuity of 20/50 or better; 7 eyes were observed, and 3 eyes with progressive visual loss to <20/50 underwent vitrectomy and membrane peeling. Group 2: 10 consecutive eyes with presenting visual acuity of 20/60 or worse underwent vitrectomy and membrane peeling. MAIN OUTCOME MEASURES Visual acuity, cataract formation, ERM recurrence, operative complications. RESULTS Group 1: With no surgery, visual acuity remained stable or improved in 5 of 10 eyes (50%), with a mean follow-up of 3.7 years. Three of 10 eyes (30%) had visual loss < or =20/60 develop and underwent vitrectomy. Postoperative visual acuity improved an average of 6 lines with a mean follow-up of 17.6 months. Group 2: After vitrectomy, visual acuity improved 2 or more lines in 7 of 10 eyes (70%), with a mean improvement of 4.4 lines and mean follow-up of 29.2 months. Groups 1 and 2: Three of 13 eyes (23%) that underwent vitrectomy had recurrent ERM formation. CONCLUSIONS Young subjects with idiopathic macular ERMs and a presenting visual acuity of 20/50 or better had a favorable visual outcome with observation. Subjects with an initial vision of 20/60 or worse, or those who had a visual decrease to < or =20/60 had significantly improved visual acuity after vitrectomy. ERM recurrence is relatively high after surgery.
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Affiliation(s)
- M J Banach
- Retina Consultants, PC, Camp Hill, Pennsylvania, USA
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Sarrafizadeh R, Ruby AJ, Hassan TS, Williams GA, Garretson BR, Trese MT, Margherio RR. A comparison of visual results and complications in eyes with posterior chamber intraocular lens dislocation treated with pars plana vitrectomy and lens repositioning or lens exchange. Ophthalmology 2001; 108:82-9. [PMID: 11150269 DOI: 10.1016/s0161-6420(00)00410-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To compare the visual results and the postoperative complications in eyes with posterior chamber intraocular lens (PCIOL) dislocation that underwent pars plana vitrectomy with lens repositioning with eyes that underwent pars plana vitrectomy with lens exchange. DESIGN Nonrandomized consecutive comparative case series. PARTICIPANTS Fifty-nine eyes (27 right eyes and 32 left eyes) of 56 subjects (28 women and 28 men) ranging in age from 59 to 90 years. Mean follow-up was 34 months. METHODS A comparison of the best-corrected preoperative visual acuities, final visual acuities, and postoperative complications in subjects with dislocated PCIOLs that underwent pars plana vitrectomy. Logarithm of the minimum angle of resolution (LogMAR)-converted visual acuities were used for comparison. Categorical data were analyzed by Fisher's exact test, and population means were compared by a pooled Student's t test. MAIN OUTCOME MEASURES Final mean visual acuities, change in mean visual acuities, and postoperative complications. RESULTS For all 59 eyes the mean preoperative visual acuity was 20/152, and the mean final visual acuity was 20/48. Final visual results were similar between the eyes that underwent lens repositioning (20/55) and the eyes that underwent lens exchange (20/43; P = 0.19). Final visual results were also similar between the eyes that underwent lens exchange with sutured PCIOL placement (20/51) and the eyes that underwent lens exchange with anterior chamber intraocular lens (ACIOL) placement (20/38; P = 0.26). Final mean visual acuity in eyes that received an ACIOL (20/38) was better than in eyes that underwent repositioning of the dislocated lens into the ciliary sulcus (20/65; P = 0.01). The mean increase in visual acuities was greater for eyes with ACIOL placement compared with eyes with sutured PCIOL placement (P = 0.01). For all eyes, final visual results were unaffected by a concurrent diagnosis of age-related macular degeneration (20/52; P: = 0.71), glaucoma (20/48; P = 0.95), or postoperative cystoid macular edema (20/55; P = 0.45). Final visual acuities were significantly worse in eyes with a detectable preoperative afferent pupillary defect (20/200; P<0.0001). Postoperative retinal detachments developed in 4 of 29 eyes (14%) that underwent lens repositioning and in 2 of 30 eyes (7%) that had lens exchange (P = 0.42). Postoperative lens subluxations occurred in 6 of 29 eyes (21%) that underwent lens repositioning and in 1 of 30 eyes (3%) that underwent lens exchange (P = 0.05). CONCLUSIONS The final visual results in eyes with dislocated PCIOLs that underwent pars plana vitrectomy with lens repositioning were similar to the visual results obtained in eyes that underwent pars plana vitrectomy with lens exchange. For eyes that underwent lens exchange, final visual results in eyes that received an ACIOL were similar to the visual results obtained in eyes that received a PCIOL; however, eyes with an ACIOL showed a greater increase in mean visual acuity. Eyes with a preoperative afferent pupillary defect had worse final visual results.
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Affiliation(s)
- R Sarrafizadeh
- Associated Retinal Consultants, PC, William Beaumont Hospital, Royal Oak, Michigan, USA
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Berinstein DM, Hassan TS, Williams GA, Margherio RR, Ruby AJ, Garretson BR. Surgical repair of full-thickness idiopathic macular holes associated with significant macular drusen. Ophthalmology 2000; 107:2233-9. [PMID: 11097602 DOI: 10.1016/s0161-6420(00)00417-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the visual and anatomic results of surgically repaired macular holes in eyes with intermediate or large-sized macular drusen. DESIGN Retrospective noncomparative case series. PARTICIPANTS Thirty-four eyes of 32 patients undergoing macular hole surgery with preoperative intermediate or large-sized macular drusen as defined by the Age-Related Eye Disease Study (AREDS). INTERVENTION Pars plana vitrectomy for standard macular hole repair performed by multiple surgeons. MAIN OUTCOME MEASURES Visual acuity, anatomic hole closure. RESULTS Initial hole closure failed in 8 eyes (24%) overall, 5 of 28 eyes (18%) with AREDS category 2 drusen and 3 of 6 eyes (50%) with category 3 drusen (P = 0.1263). Final macular hole closure was seen in 93% of category 2 and 67% of category 3 eyes (P = 0.1347). Mean final visual acuity was 20/60 overall, 20/60 for category 2, and 20/50 for category 3 eyes. CONCLUSIONS A trend of reduced initial macular hole closure was seen in eyes with significant macular drusen. Reoperation improved closure rates. If closure was accomplished, visual outcomes were excellent.
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Affiliation(s)
- D M Berinstein
- Associated Retinal Consultants, PC, Department of Ophthalmology, Beaumont Eye Institute, Royal Oak, Michigan, USA
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Mansur AH, Williams GA, Bishop DT, Markham AF, Lewis S, Britton J, Morrison JF. Evidence for a role of HLA DRB1 alleles in the control of IgE levels, strengthened by interacting TCR A/D marker alleles. Clin Exp Allergy 2000; 30:1371-8. [PMID: 10998012 DOI: 10.1046/j.1365-2222.2000.00944.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND MHC class II alleles at human chromosome 6p21.1 and alleles in the TCR A/D locus at human chromosome 14q11.2 have been implicated in susceptibility to specific allergies and the modulation of total serum IgE. It has also been hypothesized that HLA and TCR allelic interactions may have a strong influence on predisposition to allergic disease. OBJECTIVE This study was performed to investigate the influence of HLA-DRB and DQB1 alleles and D14S50 alleles (adjacent to TCR A/D locus on 14q11.2), individually and in-combination, on total serum IgE levels, and on the development of specific allergies. METHODS We performed an association study between HLA-DRB, HLA-DQB1 polymorphisms, D14S50 alleles, total serum IgE expression and specific allergies to house dust mite, grass pollens and cat fur. A sample of 181 individuals was drawn from a larger set of 2415 adults, sampled at random from a district in Nottingham. RESULTS Strong association was observed between HLA-DRB1*0701 allele and high total serum IgE expression (P < 0.001). D14S50 alleles alone showed no evidence for independent association. However, there was a significant interaction between DRB1*0701 and D14S50 allele 170 such that, when both were present, there was a further increase in total serum IgE levels. CONCLUSION This study suggests that DRB1*0701 allele is involved in the modulation of total serum IgE, and that there is an interaction between DRB1*0701 and a marker adjacent to TCR A/D in the control of IgE expression.
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Affiliation(s)
- A H Mansur
- Molecular Medicine Unit, University of Leeds, Clinical Sciences Building, St. James's University Hospital, Leeds, UK
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Williams GA, Sarrafizadeh R. Antiphospholipid antibodies and retinal thrombosis in patients without risk factors: a prospective case-control study. Am J Ophthalmol 2000; 130:538-9. [PMID: 11183560 DOI: 10.1016/s0002-9394(00)00565-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
PURPOSE The purpose of this article is to demonstrate the feasibility of a surgical approach that might be possible in an office setting for idiopathic stage 3 macular holes. The posterior hyaloid of the vitreous and perihole tissue is enzymatically manipulated to create an atraumatic posterior vitreous separation and may stimulate cell proliferation to close macular holes. DESIGN Prospective noncomparative interventional case series. PARTICIPANTS Nine eyes of eight patients with idiopathic stage 3 macular holes were treated. METHODS The patients were treated with an injection of 0.4 IU of autologous plasmin enzyme into the midvitreous cavity and lavage of the vitreous cavity with an infusion light pipe and vitreous cutter followed by filling 70% to 80% of the vitreous cavity with 14% C3F8 and head-down positioning. MAIN OUTCOME MEASURES Posterior vitreous detachment, macular hole closure, and vision improvement. RESULTS Eight of nine eyes showed a spontaneous posterior vitreous detachment. One eye required minimal suction of less than 50 mmHg to elevate the posterior hyaloid off the retinal surface. Eyes were followed for a minimum of 6 months. All holes closed, and there was an average visual acuity improvement of four lines. The average surgical time for this procedure was 20 minutes. CONCLUSIONS Autologous plasmin enzyme-assisted vitreous surgery techniques can reduce operative time, expense, and patient inconvenience while maintaining excellent surgical results, which may allow office-based vitreous surgery for idiopathic stage 3 macular holes.
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Affiliation(s)
- M T Trese
- Associated Retinal Consultants, PC, Royal Oak, Michigan, USA
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Pendergast SD, Hassan TS, Williams GA, Cox MS, Margherio RR, Ferrone PJ, Garretson BR, Trese MT. Vitrectomy for diffuse diabetic macular edema associated with a taut premacular posterior hyaloid. Am J Ophthalmol 2000; 130:178-86. [PMID: 11004291 DOI: 10.1016/s0002-9394(00)00472-4] [Citation(s) in RCA: 192] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the role of vitrectomy in eyes with diffuse diabetic macular edema associated with a taut posterior hyaloid. METHODS Records of 55 eyes of 50 patients with diabetic retinopathy and diffuse clinically significant diabetic macular edema who underwent vitrectomy with stripping of the premacular posterior hyaloid were reviewed. In all 55 eyes, diffuse diabetic macular edema was present on contact lens examination and confirmed with fluorescein angiography. On fundus examination, the premacular posterior hyaloid was attached and appeared taut. RESULTS The mean preoperative best-corrected visual acuity was 20/160, and the mean final best-corrected visual acuity was 20/80 (P <.0001, Wilcoxon signed rank test), with 27 (49.1%) of the 55 eyes demonstrating improvement in best-corrected visual acuity of 2 or more lines. Fifty-two (94.5%) of the 55 vitrectomized eyes showed improvement in clinically significant macular edema and in 45 eyes (81.8%) the macular edema resolved completely during a mean period of 4.5 months (range, 1 to 13 months). Eyes with macular ischemia and preoperative best-corrected visual acuity of 20/200 or less tended to respond less favorably to vitrectomy than eyes lacking these characteristics. All eyes had at least 6 months of follow-up after surgery, with a mean follow-up of 23.2 months. CONCLUSION In eyes with persistent diffuse diabetic macular edema with a taut premacular posterior hyaloid face unresponsive to laser therapy, vitrectomy with removal of the posterior hyaloid appears to be beneficial in some cases. Careful selection of eyes with favorable preoperative clinical characteristics may improve surgical outcomes.
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Affiliation(s)
- S D Pendergast
- Retina Associates of Cleveland, Inc, Beachwood, Ohio 44122, USA.
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McCabe CM, Flynn HW, McLean WC, Brod RD, McDonald HR, Johnson MW, Williams GA, Mieler WF. Nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms. Arch Ophthalmol 2000; 118:780-5. [PMID: 10865314 DOI: 10.1001/archopht.118.6.780] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To report visual acuity outcomes of nonsurgical management of macular hemorrhage secondary to retinal artery macroaneurysms. METHODS Forty-one patients at multiple centers with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone were reviewed. Time to clearance of macular hemorrhage, visual acuity at final follow-up, and presence or absence of macular pigmentary changes after absorption of the hemorrhage were recorded for each patient. RESULTS On initial examination, visual acuity was 20/200 or worse in all except 4 patients (3 with 20/70, 1 with 20/80). At an average follow-up of 15. 7 months, a final visual acuity of 20/40 or better was achieved in 15 eyes (37%), between 20/50 and 20/100 in 12 (29%), and 20/200 or worse in 14 (34%). Macular pigmentary abnormalities were noted after clearance of the hemorrhage in 23 (56%) of 41 cases, and these eyes generally had worse visual acuity outcomes. CONCLUSIONS In eyes with macular hemorrhage secondary to retinal artery macroaneurysms managed with observation alone, good visual acuity outcomes can often be achieved. Poorer visual acuity outcomes are associated with macular pigmentary changes after resorption of blood. Arch Ophthalmol. 2000;118:780-785
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Affiliation(s)
- C M McCabe
- Bascom Palmer Eye Institute, 900 NW 17th St, Miami, FL 33136, USA.
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Affiliation(s)
- M J Banach
- Associated Retinal Consultants, Royal Oak, MI 48073, USA
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